Organization
GHASSAN KHOURY DMD PC
Active
Other names
KAPPA dental group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GHASSAN A KHOURY DMD (PRESIDENT)
(617) 666-4444
Entity
Organization
Contact information
Practice address
402 WASHINGTON ST, SOMERVILLE, MA 02143-3823
(617) 666-4444
(617) 666-1113
Mailing address
402 WASHINGTON ST, SOMERVILLE, MA 02143-3823
(617) 666-4444
(617) 666-1113
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
20411
MA
122300000X
Dentist
20622
MA
122300000X
Dentist
20871
MA
1223E0200X
Endodontics
20377
MA
1223P0300X
Periodontics
21922
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
X11554
BLUE CROSS BLUE SHIELD
MA
Enumeration date
07/02/2008
Last updated
07/02/2008
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