NPIMap

Organization Active NPI

Dental Implant & Periodontal Surgeons of Maine Line, P.C.

Doing business as Sam B. Khoury, D.D.S., M.S.

  • Periodontics
  • Chadds Ford, PA
National Provider Identifier
1477003531
Registry record updated Jul 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
DS037420 Issued in PA
Legal business name
DENTAL IMPLANT & PERIODONTAL SURGEONS OF MAINE LINE, P.C.
Doing business as
Sam B. Khoury, D.D.S., M.S.
Practice address
107 Commons CT
Chadds Ford, PA 19317
Phone
(610) 500-0610
NPI assigned
Oct 12, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Samer B Khoury, D.D.S., M.S.NPI 1568541498
Title
Periodontist
Phone
(610) 500-0610

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0300X DS037420 PA Primary

Addresses

Primary practice location

107 Commons CT
Chadds Ford, PA 19317

Mailing address

107 Commons CT
Chadds Ford, PA 19317-9708
Phone (610) 500-0610

Other names 1

  • Sam B. Khoury, D.D.S., M.S. Doing business as

National Provider Directory

National Provider Directory

Locations

107 Commons Ct
Chadds Ford, PA 19317
Phone (610) 500-0610

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1476230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531872000000",
    "number": "1477003531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 COMMONS CT",
            "city": "CHADDS FORD",
            "state": "PA",
            "postal_code": "193179708",
            "telephone_number": "610-500-0610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 COMMONS CT",
            "city": "CHADDS FORD",
            "state": "PA",
            "postal_code": "19317",
            "telephone_number": "610-500-0610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL IMPLANT & PERIODONTAL SURGEONS OF MAINE LINE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-12",
        "last_updated": "2018-07-18",
        "status": "A",
        "authorized_official_last_name": "KHOURY",
        "authorized_official_first_name": "SAMER",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PERIODONTIST",
        "authorized_official_telephone_number": "610-500-0610",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S., M.S."
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "PA",
            "license": "DS037420",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sam B. Khoury, D.D.S., M.S.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sam B. Khoury, D.D.S., M.S.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chadds Ford, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.