Provider Demographics
NPI:1821834078
Name:ELKHOURY, LEAH DARLA (DMD)
Entity type:Individual
Prefix:DR
First Name:LEAH
Middle Name:DARLA
Last Name:ELKHOURY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 OLEVIA ST APT 308
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-3483
Mailing Address - Country:US
Mailing Address - Phone:781-752-8274
Mailing Address - Fax:
Practice Address - Street 1:4220 VALLEY RIDGE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-5173
Practice Address - Country:US
Practice Address - Phone:904-354-0339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29256122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist