Provider Demographics
NPI:1770772626
Name:EL-KHOURY, MABELLE (DDS)
Entity type:Individual
Prefix:MISS
First Name:MABELLE
Middle Name:
Last Name:EL-KHOURY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6395 MIDWAY MALL
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-2481
Mailing Address - Country:US
Mailing Address - Phone:440-324-2600
Mailing Address - Fax:
Practice Address - Street 1:6395 MIDWAY MALL
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-2481
Practice Address - Country:US
Practice Address - Phone:440-324-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.021971122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist