Healthcare Provider Details

I. General information

NPI: 1083293088
Provider Name (Legal Business Name): JOHNNY HELOU DMD, MICOI, DICOI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6824 W GULF TO LAKE HWY
CRYSTAL RIVER FL
34429-7806
US

IV. Provider business mailing address

8 RUE DE BRAINE
BLAINVILLE QUEBEC
J7B1Z1
CA

V. Phone/Fax

Practice location:
  • Phone: 352-794-6139
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN25760
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: