Provider Demographics
NPI:1558047852
Name:KHALEK, RONNY FARES (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONNY
Middle Name:FARES
Last Name:KHALEK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 MONTGOMERY ST FL 402
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-3726
Mailing Address - Country:US
Mailing Address - Phone:201-801-4339
Mailing Address - Fax:
Practice Address - Street 1:75 MONTGOMERY ST FL 402
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-3726
Practice Address - Country:US
Practice Address - Phone:201-684-9617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2024-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD180691223G0001X
NJ22DI03017800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice