Provider Demographics
NPI:1700099306
Name:COURY, AMEEL SAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMEEL
Middle Name:SAM
Last Name:COURY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:SAM
Other - Middle Name:
Other - Last Name:COURY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:17917 N PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-8960
Mailing Address - Country:US
Mailing Address - Phone:405-348-9551
Mailing Address - Fax:405-348-2480
Practice Address - Street 1:17917 N PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-8960
Practice Address - Country:US
Practice Address - Phone:405-348-9551
Practice Address - Fax:405-348-2480
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK28821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice