1760770713 NPI number — SAM ALKHOURY DMD PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760770713 NPI number — SAM ALKHOURY DMD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAM ALKHOURY DMD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760770713
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
403 WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLISTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01746-1349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-429-7800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 MAIN ST
Provider Second Line Business Practice Location Address:
107
Provider Business Practice Location Address City Name:
MILFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01757-2502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-473-2002
Provider Business Practice Location Address Fax Number:
508-306-4333
Provider Enumeration Date:
07/12/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ALKHOURY
Authorized Official First Name:
HOUSSAM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
508-473-2002

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  DN20511 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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