Provider Demographics
NPI:1659954915
Name:RIVERWALK FAMILY DENTAL LLC
Entity Type:Organization
Organization Name:RIVERWALK FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
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:856-869-8660
Mailing Address - Street 1:658 W CUTHBERT BLVD
Mailing Address - Street 2:
Mailing Address - City:HADDON TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-3642
Mailing Address - Country:US
Mailing Address - Phone:856-869-8660
Mailing Address - Fax:
Practice Address - Street 1:658 W CUTHBERT BLVD
Practice Address - Street 2:
Practice Address - City:HADDON TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08108-3642
Practice Address - Country:US
Practice Address - Phone:856-869-8660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty