Provider Demographics
NPI:1093009250
Name:KHAROUF ORTHODONTICS GROUP, PC
Entity Type:Organization
Organization Name:KHAROUF ORTHODONTICS GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:KHAROUF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-343-4975
Mailing Address - Street 1:5150 5TH ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-6023
Mailing Address - Country:US
Mailing Address - Phone:605-343-4975
Mailing Address - Fax:
Practice Address - Street 1:5150 5TH ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-6023
Practice Address - Country:US
Practice Address - Phone:605-343-4975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM8391223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty