Individual
GEORGE KHAZOUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
1905 CONVENIENCE PL STE A, CHAMPAIGN, IL 61820-8927
(217) 355-5165
Mailing address
1905 CONVENIENCE PL STE A, CHAMPAIGN, IL 61820-8927
(217) 355-5165
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.031429
IL
122300000X
Dentist
22897
FL
1223G0001X
General Practice Dentistry
019.031429
IL
1223G0001X
General Practice Dentistry
22897
FL
Other
Enumeration date
07/14/2017
Last updated
04/21/2019
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