Provider Demographics
NPI:1568197291
Name:NEWARK DENTAL SPA LLC
Entity Type:Organization
Organization Name:NEWARK DENTAL SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:G
Authorized Official - Last Name:ELDIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:609-547-3232
Mailing Address - Street 1:164 FERRY ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-2158
Mailing Address - Country:US
Mailing Address - Phone:609-547-3232
Mailing Address - Fax:
Practice Address - Street 1:164 FERRY ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-2158
Practice Address - Country:US
Practice Address - Phone:609-547-3232
Practice Address - Fax:609-594-1179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-18
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty