Provider Demographics
NPI:1811411713
Name:KHOURI, MICHELLE (DDS)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
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 1:5925 FOLIGNO WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-2226
Mailing Address - Country:US
Mailing Address - Phone:1408-506-5083
Mailing Address - Fax:
Practice Address - Street 1:750 N CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95133-1913
Practice Address - Country:US
Practice Address - Phone:408-258-5054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1017181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice