Provider Demographics
NPI:1053660670
Name:AL-KHOURY, NAWRAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:NAWRAS
Middle Name:
Last Name:AL-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 1:2482 WONDER DR
Mailing Address - Street 2:FRIENDLY DENTAL
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-6427
Mailing Address - Country:US
Mailing Address - Phone:704-786-7007
Mailing Address - Fax:
Practice Address - Street 1:2482 WONDER DR
Practice Address - Street 2:FRIENDLY DENTAL
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-6427
Practice Address - Country:US
Practice Address - Phone:704-786-7007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC93421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice