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General NPI Number Information
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NPI Number | 1467857706
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Entity Type | Organization
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Legal Business Name | JENNA KHOURY DMD INC
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Dates
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Enumeration Date | 10/29/2014
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Last Update Date | 10/29/2014
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Provider Practice Location Address
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Address Line | 7720 RANCHO SANTA FE RD SUITE D
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City | CARLSBAD
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State | CA
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Zip | 92009
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Country | US
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Telephone | 760-889-5995
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Fax |
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Provider Business Mailing Address
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Address Line | 1309 CHERT DR
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City | SAN MARCOS
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State | CA
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Zip | 92078-2822
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Country | US
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Telephone | 858-335-5645
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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. JENNA MAJEED KHOURY
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Credential | DMD
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Telephone | 760-889-5995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 60986
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License Number State | CA
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