Ghassan A Khoury, DMD,MPH,PC
Individual provider Active NPI General Practice Dentistry · Lakeville, MA
NPI 1043395809 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1043395809
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 20411 (MA)
- Practice address
- 12 Colleen Dr
Lakeville, MA 02347-1663 - Phone
- (508) 947-0111
- Fax
- (508) 947-9815
- NPI assigned
- Oct 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150515001708 | MA | Order and Referring Only - Dentist |
3375863277 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20411 | MA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ghassan Khoury DMD, PC | General Practice | Current | Accepting new patients |
| Commonwealth Mobile Oral Health Services, LLC | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 20411 | MA | Yes |
Addresses
Primary practice location
12 Colleen Dr
Lakeville, MA 02347-1663
Mailing address
12 Colleen Dr
Lakeville, MA 02347-1663
Phone (508) 947-0111
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0202690 | Medicaid | MA | |
| 02329784 | Medicaid | NY | |
| 30303081 | Medicaid | NH |
Other providers in Lakeville, MA
- Illumination Psychotherapy Services, LLC.
- In Sight Healing and Counseling LLC
- Island Terrace, Inc.
- Rhiannon Jackson
- Ginny Lynn Kelly
- Cherie Kish
- Jennifer L Koester
- Judy Kohut
- Lakeside Mental Health, PLLC
- Lakeville Chiropractic, Inc
All providers in Lakeville, MA · General Practice Dentistry in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.