Healthcare Provider Details

I. General information

NPI: 1780841767
Provider Name (Legal Business Name): KHOURY DENTAL CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S LAPEER RD STE 100
OXFORD MI
48371-6102
US

IV. Provider business mailing address

1120 S LAPEER RD STE 100
OXFORD MI
48371-6102
US

V. Phone/Fax

Practice location:
  • Phone: 248-969-7645
  • Fax: 248-969-7646
Mailing address:
  • Phone: 248-969-7645
  • Fax: 248-969-7646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901018892
License Number StateMI

VIII. Authorized Official

Name: DR. JOHN MICHAEL KHOURY JR.
Title or Position: MEMBER
Credential: D.D.S.
Phone: 248-969-7645