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General NPI Number Information
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NPI Number | 1710116819
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Entity Type | Individual
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Provider Name | SAM F KHOURY D.M.D
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Gender | Male
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Dates
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Enumeration Date | 07/09/2009
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Last Update Date | 03/16/2011
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Provider Practice Location Address
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Address Line | 3000 ALAMO DR STE 206
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City | VACAVILLE
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State | CA
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Zip | 95687-6352
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Country | US
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Telephone | 707-451-1311
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Fax | 707-451-1325
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Provider Business Mailing Address
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Address Line | 1321 WEBSTER ST #D308
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City | ALAMEDA
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State | CA
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Zip | 94501-3871
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Country | US
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Telephone | 510-522-2571
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Fax | 510-522-2571
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 57670
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License Number State | CA
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