MEDICARE: DR. JOHNNY EL HELOU DMD, MICOI, DICOI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN25760	FL

General Provider Information

NPI Number	:	1083293088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHNNY EL HELOU DMD, MICOI, DICOI

Provider Business Mailing Address
First Line	:	8 RUE DE BRAINE
Second Line	:
City	:	BLAINVILLE
State	:	QUEBEC
Zip	:	J7B1Z1
Country	:	CA
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1650 N FEDERAL HWY STE 105
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-3200
Country	:	US
Telephone Number	:	954-946-4867
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2021
Last Update Date	:	04/06/2021

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