Active NPI
Charles Pierre Khoury
- General Practice Dentistry
- Fairhaven, MA
National Provider Identifier
1124000393
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 20015
- Practice address
- 404 Huttleston Ave
1St Floor
Fairhaven, MA 02719-5630 - Phone
- (508) 997-7776
- Fax
- (508) 997-0776
- NPI assigned
- Nov 15, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 20015 | MA | Primary |
Addresses
Primary practice location
404 Huttleston Ave
1St Floor
Fairhaven, MA 02719-5630
Mailing address
1428 Dartmouth Woods Drive
Dartmouth, MA 02747
Phone (508) 997-7776
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| X12286 | Other | MA | BCBS OF MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20015 | MA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Charles Khoury, DMD, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dental Clinic/Center
- Fairhaven, MA
- NPI 1043309941
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132012800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124000393",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1428 DARTMOUTH WOODS DRIVE",
"city": "DARTMOUTH",
"state": "MA",
"postal_code": "02747",
"telephone_number": "508-997-7776"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "404 HUTTLESTON AVE",
"address_2": "1ST FLOOR",
"city": "FAIRHAVEN",
"state": "MA",
"postal_code": "027195630",
"telephone_number": "508-997-7776",
"fax_number": "508-997-0776"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHOURY",
"first_name": "CHARLES",
"middle_name": "PIERRE",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-11-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MA",
"license": "20015",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF MA",
"identifier": "X12286",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairhaven, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.