MEDICARE: HARRY J. KOURI, JR., D.D.S.,P.A.

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	122300000X	Dentist	5026	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	116606	OTHER	KS	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1417085317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARRY J. KOURI, JR., D.D.S.,P.A.

Provider Business Mailing Address
First Line	:	6611 E CENTRAL AVE
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67206-1937
Country	:	US
Telephone Number	:	316-686-3140
Fax Number	:	316-686-1107

Provider Business Practice Location Address
First Line	:	6611 E CENTRAL AVE
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67206-1937
Country	:	US
Telephone Number	:	316-686-3140
Fax Number	:	316-686-1107

Authorized Official
Title or Position	:	OWNER
Name	:	DR. HARRY J KOURI JR.
Credential	:	D.D.S.
Telephone Number	:	316-686-3140

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	08/22/2020

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