Provider Demographics
NPI:1437774023
Name:ENGLEWOOD DENTAL ARTS LLC
Entity Type:Organization
Organization Name:ENGLEWOOD DENTAL ARTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE
Authorized Official - Prefix:
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-736-6656
Mailing Address - Street 1:3333 ROUTE 9 N
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2691
Mailing Address - Country:US
Mailing Address - Phone:732-679-6666
Mailing Address - Fax:732-679-6676
Practice Address - Street 1:106 GRAND AVE STE 390
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-3570
Practice Address - Country:US
Practice Address - Phone:201-816-8696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental