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General NPI Number Information
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NPI Number | 1043309941
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Entity Type | Organization
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Legal Business Name | CHARLES KHOURY, DMD, INC.
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 404 HUTTLESTON AVE 1ST FLOOR
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City | FAIRHAVEN
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State | MA
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Zip | 02719
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Country | US
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Telephone | 508-997-7776
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Fax |
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Provider Business Mailing Address
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Address Line | 1428 DARTMOUTH WOODS DRIVE
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City | DARTMOUTH
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State | MA
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Zip | 02747
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES KHOURY
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Credential | DMD
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Telephone | 508-997-7776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 20015
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License Number State | MA
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