MEDICARE: DR. MARC AL KHOURY DMD

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	DN28499	FL

General Provider Information

NPI Number	:	1295188787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC AL KHOURY DMD

Provider Business Mailing Address
First Line	:	1850 S OCEAN DR APT 3407
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-7686
Country	:	US
Telephone Number	:	647-971-9876
Fax Number	:

Provider Business Practice Location Address
First Line	:	4595 NORTHLAKE BLVD STE 103
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-4647
Country	:	US
Telephone Number	:	561-427-7711
Fax Number	:

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

Provider Enumeration Date	:	07/19/2016
Last Update Date	:	10/17/2023

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