Provider Demographics
NPI:1295188787
Name:AL KHOURY, MARC (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:AL KHOURY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 S OCEAN DR APT 3407
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-7686
Mailing Address - Country:US
Mailing Address - Phone:647-971-9876
Mailing Address - Fax:
Practice Address - Street 1:4595 NORTHLAKE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-4647
Practice Address - Country:US
Practice Address - Phone:561-427-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN28499122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist