Provider Demographics
NPI:1619192259
Name:KHURI-NASRALLAH, GHASSAN G (DDS)
Entity type:Individual
Prefix:DR
First Name:GHASSAN
Middle Name:G
Last Name:KHURI-NASRALLAH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 COPLEY ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1239
Mailing Address - Country:US
Mailing Address - Phone:713-203-8487
Mailing Address - Fax:
Practice Address - Street 1:118 CONCORD ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8304
Practice Address - Country:US
Practice Address - Phone:508-270-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18550381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice