Provider Demographics
NPI:1710116819
Name:KHOURY, SAM F (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:F
Last Name:KHOURY
Suffix:
Gender:M
Credentials:DMD
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Mailing Address - Street 1:1321 WEBSTER ST
Mailing Address - Street 2:#D308
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-3871
Mailing Address - Country:US
Mailing Address - Phone:510-522-2571
Mailing Address - Fax:510-522-2571
Practice Address - Street 1:3000 ALAMO DR STE 206
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-6352
Practice Address - Country:US
Practice Address - Phone:707-451-1311
Practice Address - Fax:707-451-1325
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2011-03-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA576701223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery