George Khazoum, D.D.S
Dentist in Champaign, IL. Individual provider (NPI-1).
NPI number1669994232
StatusActive
Last updated in NPPESApr 21, 2019
Details
- NPI
- 1669994232
- Entity type
- Individual (NPI-1)
- Name
- George Khazoum
- Credential
- D.D.S
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jul 14, 2017
- Last updated
- Apr 21, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 019.031429 | IL | Yes |
| 122300000X | Dentist | 22897 | FL | |
| 1223G0001X | Dentist, General Practice | 019.031429 | IL | |
| 1223G0001X | Dentist, General Practice | 22897 | FL |
Practice location
1905 Convenience Pl Ste AChampaign, IL 61820-8927
Phone 217-355-5165
Mailing address
1905 Convenience Pl Ste AChampaign, IL 61820-8927
Phone 217-355-5165
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