Provider Demographics
NPI:1831301738
Name:KOURY, JOHN G (D D S)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:KOURY
Suffix:
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 W HAMILTON ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-6337
Mailing Address - Country:US
Mailing Address - Phone:610-432-1322
Mailing Address - Fax:610-432-2225
Practice Address - Street 1:2200 W HAMILTON ST
Practice Address - Street 2:SUITE 304
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-6337
Practice Address - Country:US
Practice Address - Phone:610-432-1322
Practice Address - Fax:610-432-2225
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028295L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice