Provider Demographics
NPI:1083293088
Name:EL HELOU, JOHNNY (DMD, MICOI, DICOI)
Entity Type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:
Last Name:EL HELOU
Suffix:
Gender:M
Credentials:DMD, MICOI, DICOI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 RUE DE BRAINE
Mailing Address - Street 2:
Mailing Address - City:BLAINVILLE
Mailing Address - State:QUEBEC
Mailing Address - Zip Code:J7B1Z1
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1650 N FEDERAL HWY STE 105
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-3200
Practice Address - Country:US
Practice Address - Phone:954-946-4867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN25760122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist