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General NPI Number Information
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NPI Number | 1255629531
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Entity Type | Organization
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Legal Business Name | DIVINE DENTAL ARTS PC
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Dates
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Enumeration Date | 07/20/2011
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Last Update Date | 07/20/2011
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Provider Practice Location Address
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Address Line | 40 BUCKWALTER RD SUITE 309
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City | ROYERSFORD
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State | PA
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Zip | 19468
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Country | US
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Telephone | 610-616-3641
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Fax |
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Provider Business Mailing Address
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Address Line | 40 BUCKWALTER RD SUITE 309
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City | ROYERSFORD
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State | PA
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Zip | 19468
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Country | US
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Telephone | 610-616-3641
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. SAMER KHOURY
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Credential | DDS MS
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Telephone | 610-616-3641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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