Healthcare Provider Details

I. General information

NPI: 1790112787
Provider Name (Legal Business Name): SADDLE BROOK DENTAL ASSOCIATE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2013
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 5TH ST
SADDLE BROOK NJ
07663-6216
US

IV. Provider business mailing address

220 5TH ST
SADDLE BROOK NJ
07663-6216
US

V. Phone/Fax

Practice location:
  • Phone: 973-478-1616
  • Fax:
Mailing address:
  • Phone: 973-478-1616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDI 21284
License Number StateNJ

VIII. Authorized Official

Name: DR. KHALED ELDIN
Title or Position: PRESIDENT
Credential: DDS
Phone: 973-478-1616