Provider Demographics
NPI:1609858646
Name:KHOURI, RHONDA IBRAHIM (DDS)
Entity Type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:IBRAHIM
Last Name:KHOURI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7257 W 87TH ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60455-1821
Mailing Address - Country:US
Mailing Address - Phone:708-233-6512
Mailing Address - Fax:708-233-6513
Practice Address - Street 1:7257 W 87TH ST
Practice Address - Street 2:
Practice Address - City:BRIDGEVIEW
Practice Address - State:IL
Practice Address - Zip Code:60455-1821
Practice Address - Country:US
Practice Address - Phone:708-233-6512
Practice Address - Fax:708-233-6513
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist