1073611810 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 1073611810 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:
1073611810
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 PLEASANT ST
Provider Second Line Business Mailing Address:
#210
Provider Business Mailing Address City Name:
WORCESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-757-3173
Provider Business Mailing Address Fax Number:
508-757-3760

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 PLEASANT ST
Provider Second Line Business Practice Location Address:
#210
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-757-3173
Provider Business Practice Location Address Fax Number:
508-757-3760
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ALKHOURY
Authorized Official First Name:
SAM
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
508-757-3173

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  20511 , 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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