Provider Demographics
NPI:1215069752
Name:KHOURY, RAMI A (DMD)
Entity type:Individual
Prefix:DR
First Name:RAMI
Middle Name:A
Last Name:KHOURY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18015-4101
Mailing Address - Country:US
Mailing Address - Phone:610-691-3311
Mailing Address - Fax:610-317-6052
Practice Address - Street 1:1003 BROADWAY
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-4101
Practice Address - Country:US
Practice Address - Phone:610-691-3311
Practice Address - Fax:610-317-6052
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS035891122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist