Provider Demographics
NPI:1639371347
Name:ALWAN, KHALED Y (DDS)
Entity Type:Individual
Prefix:DR
First Name:KHALED
Middle Name:Y
Last Name:ALWAN
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 1:194 FRENCH HILL RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3932
Mailing Address - Country:US
Mailing Address - Phone:973-872-2603
Mailing Address - Fax:
Practice Address - Street 1:222 HALEDON AVE
Practice Address - Street 2:
Practice Address - City:PROSPECT PARK
Practice Address - State:NJ
Practice Address - Zip Code:07508-2024
Practice Address - Country:US
Practice Address - Phone:973-904-9611
Practice Address - Fax:973-904-0857
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI017959001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice