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General NPI Number Information
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NPI Number | 1235448440
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Entity Type | Organization
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Legal Business Name | DENTAL IMPLANT & PERIODONTAL SURGEONS, P.C.
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Dates
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Enumeration Date | 10/05/2010
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Last Update Date | 07/18/2018
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Provider Practice Location Address
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Address Line | 638 NEWTOWN YARDLEY RD STE 1C
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City | NEWTOWN
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State | PA
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Zip | 18940
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Country | US
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Telephone | 159-689-6012
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Fax |
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Provider Business Mailing Address
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Address Line | 638 NEWTOWN YARDLEY RD STE 1C
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City | NEWTOWN
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State | PA
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Zip | 18940-1737
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Country | US
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Telephone | 215-968-9601
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SAMER KHOURY
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Credential | DDS MS
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Telephone | 215-968-9601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DS037420
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License Number State | PA
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