GEORGE KHAZOUM (NPI# 1669994232) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669994232 |
| Entity Type | Individual |
| Full Name | GEORGE KHAZOUM |
| Credential | D.D.S |
| Practice Address |
1905 Convenience Pl Ste A Champaign IL 61820-8927 |
| Practice Telephone | 2173555165 |
| Mailing Telephone | 2173555165 |
| Enumeration Date | 2017-07-14 |
| Last Update Date | 2019-04-21 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | 019.031429 | IL | Dental Providers |
| N | 122300000X | Dentist | 22897 | FL | Dental Providers |
| N | 1223G0001X |
Dentist Specialization: General Practice |
019.031429 | IL | Dental Providers |
| N | 1223G0001X |
Dentist Specialization: General Practice |
22897 | FL | Dental Providers |
| Street Address |
1905 CONVENIENCE PL STE A |
| City | CHAMPAIGN |
| State | IL |
| Zip Code | 61820-8927 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457918716 | Tejpalsinh Jadeja | Dentist | 1905 Convenience Pl Ste A, Champaign, IL 61820-8927 | 2019-05-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982217345 | Costco Wholesale Corporation | Pharmacy | 2002 N. Neil St., Champaign, IL 61820 | 2020-08-26 |
| 1255963583 | Jamey Richard Bailey | Social Worker | 701 Devonshire Drive, Bldg C, Suite 206, C-6, Champaign, IL 61820 | 2020-02-05 |
| 1790247443 | Jason Abrams | Counselor | 201 W Springfield Ave., Suite 1002-1003, Champaign, IL 61820 | 2019-04-02 |
| 1184100273 | Janine Rafferty | Pharmacist | 2002 N Neil St, Champaign, IL 61820 | 2018-07-12 |
| 1417475070 | Brodbeck Counseling, PC | Community/Behavioral Health | 301 N. Neil Street Suite 323, Champaign, IL 61820 | 2017-09-05 |
| 1447773726 | Quanata M Pelmore | Nurse's Aide | 508 E. Vine St, Champaign, IL 61820 | 2017-07-19 |
| 1821518127 | Molly Mclay | Social Worker | 309 W Clark St., Champaign, IL 61820 | 2017-06-27 |
| 1396265849 | Lou Echols Chambers | Audiologist | 901 South Sixth Street, Chamapign, IL 61820 | 2017-06-26 |
| 1962874495 | Luciana Angelica Guardini | Social Worker | 100 North Chestnut Street, Suite 244, Champaign, IL 61820 | 2015-10-23 |
| 1538544465 | Cpo Services, Inc. | Prosthetic/Orthotic Supplier | 410 E University Ave Ste 105, Champaign, IL 61820 | 2015-07-21 |
| Find all providers in zip 61820 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184008708 | Seunghyun Jae | Dentist | 1905 W Springfield Ave, Champaign, IL 61821 | 2015-07-14 |
| 1700034089 | Leonor Cecilia Villalta | Dentist | 2547 W Springfield Ave Apt 2, Champaign, IL 61821-2821 | 2008-08-28 |
| 1619133105 | Jeffrey D Colin | Dentist | 703 S Neil St Ste B, Champaign, IL 61820-5236 | 2008-08-04 |
| 1801051552 | David Wesley Bacheller | Dentist | 305 W Clark St, Champaign, IL 61820-4638 | 2008-07-22 |
| 1992971477 | Lindsey A Hans | Dentist | 2918 Crossing Ct Ste A, Champaign, IL 61822-6100 | 2008-05-05 |
| 1114056272 | Erika Ynga | Dentist | 703 S Neil St, Champaign, IL 61820-5223 | 2007-03-05 |
| 1851420475 | Jim W Yu | Dentist | 1905 Convenience Pl, Suite A, Champaign, IL 61820-8926 | 2007-03-02 |
| 1194866699 | Bruce Gail Sammons | Dentist | 3003 Village Office Place, Champaign, IL 61822-7674 | 2007-02-09 |
| 1316001654 | James Robert Fleming | Dentist | 2004 Fox Dr, Suite F, Champaign, IL 61820-7336 | 2006-12-21 |
| 1659430031 | Nusrat A Hawa | Dentist | 4906 Peifer Ln, Champaign, IL 61822-8321 | 2006-12-08 |
| Find all providers in CHAMPAIGN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.