Provider Demographics
NPI:1710289467
Name:KHOURI, GINA JABER (DDS)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:JABER
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 1:1 LANSDALE CT
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-0322
Mailing Address - Country:US
Mailing Address - Phone:949-364-2528
Mailing Address - Fax:
Practice Address - Street 1:1 LANSDALE CT
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-0322
Practice Address - Country:US
Practice Address - Phone:949-364-2528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA597131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice