Provider Demographics
NPI:1083840912
Name:KOURY, KATHRYN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:KOURY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 N MAIN ST
Mailing Address - Street 2:#1
Mailing Address - City:MANSFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16933-1432
Mailing Address - Country:US
Mailing Address - Phone:570-662-2886
Mailing Address - Fax:
Practice Address - Street 1:17 N MAIN ST
Practice Address - Street 2:#1
Practice Address - City:MANSFIELD
Practice Address - State:PA
Practice Address - Zip Code:16933-1432
Practice Address - Country:US
Practice Address - Phone:570-662-2886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0378885122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist