Provider Demographics
NPI:1790301752
Name:ELKHATIB, NOUR (DMD)
Entity Type:Individual
Prefix:DR
First Name:NOUR
Middle Name:
Last Name:ELKHATIB
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 1:10086 COVE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-3764
Mailing Address - Country:US
Mailing Address - Phone:407-864-9198
Mailing Address - Fax:
Practice Address - Street 1:3226 LAKE WASHINGTON RD STE 16
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32934-7620
Practice Address - Country:US
Practice Address - Phone:321-255-1991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN25032122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist