MEDICARE: KHAROUF ORTHODONTICS GROUP, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	M839	SD

General Provider Information

NPI Number	:	1093009250
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KHAROUF ORTHODONTICS GROUP, PC

Provider Business Mailing Address
First Line	:	5150 5TH ST
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-6023
Country	:	US
Telephone Number	:	605-343-4975
Fax Number	:

Provider Business Practice Location Address
First Line	:	5150 5TH ST
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-6023
Country	:	US
Telephone Number	:	605-343-4975
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN GEORGE KHAROUF
Credential	:
Telephone Number	:	605-343-4975

Provider Enumeration Date	:	06/06/2011
Last Update Date	:	06/06/2011

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