Provider Demographics
NPI:1033469424
Name:JAMIL ALKHOURY DDS INC
Entity Type:Organization
Organization Name:JAMIL ALKHOURY DDS INC
Other - Org Name:JAMIL ALKHOURY DDS INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALKHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-344-5296
Mailing Address - Street 1:4411 BALFOUR RD STE C
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-1526
Mailing Address - Country:US
Mailing Address - Phone:925-344-5296
Mailing Address - Fax:925-240-1383
Practice Address - Street 1:4411 BALFOUR RD STE C
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-1526
Practice Address - Country:US
Practice Address - Phone:925-240-1380
Practice Address - Fax:925-240-1383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-13
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46731305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization