MEDICARE: DR. JOHN GEORGE KHAROUF DDS MS

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	:	1376550129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN GEORGE KHAROUF DDS MS

Provider Business Mailing Address
First Line	:	5150 FIFTH STREET
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-6023
Country	:	US
Telephone Number	:	605-343-4975
Fax Number	:	605-388-8702

Provider Business Practice Location Address
First Line	:	5150 FIFTH STREET
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-6023
Country	:	US
Telephone Number	:	605-343-4975
Fax Number	:	605-388-8702

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	07/08/2007

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