Provider Demographics
NPI:1861501520
Name:KHOURY, NICOLA ELIAS (DDS)
Entity Type:Individual
Prefix:
First Name:NICOLA
Middle Name:ELIAS
Last Name:KHOURY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 N JACKSON AVE
Mailing Address - Street 2:SUITE #3
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1606
Mailing Address - Country:US
Mailing Address - Phone:408-259-7900
Mailing Address - Fax:408-259-1785
Practice Address - Street 1:266 N JACKSON AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1606
Practice Address - Country:US
Practice Address - Phone:408-259-7900
Practice Address - Fax:408-259-1785
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35744122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist