NPIMap

Organization Active NPI

Riverwalk Family Dental LLC

  • Dentist
  • Haddon Township, NJ
National Provider Identifier
1659954915
Registry record updated May 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
RIVERWALK FAMILY DENTAL LLC
Practice address
658 W Cuthbert Blvd
Haddon Township, NJ 08108-3642
Phone
(856) 869-8660
NPI assigned
May 4, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Khaled G Eldin, DDSNPI 1720143415
Title
Owner
Phone
(856) 869-8660

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

658 W Cuthbert Blvd
Haddon Township, NJ 08108-3642

Mailing address

658 W Cuthbert Blvd
Haddon Township, NJ 08108-3642
Phone (856) 869-8660

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251111001426 NJ Part B Supplier - Clinic/Group Practice 3971094699 Receives reassigned benefits from 1 practitioner
Practice locations: Haddon Township, NJ

National Provider Directory

National Provider Directory

Locations

658 W Cuthbert Blvd
Haddon Township, NJ 08108
Phone (856) 869-8660

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1620086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620086400000",
    "number": "1659954915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "658 W CUTHBERT BLVD",
            "city": "HADDON TOWNSHIP",
            "state": "NJ",
            "postal_code": "081083642",
            "telephone_number": "856-869-8660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "658 W CUTHBERT BLVD",
            "city": "HADDON TOWNSHIP",
            "state": "NJ",
            "postal_code": "081083642",
            "telephone_number": "856-869-8660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERWALK FAMILY DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-04",
        "last_updated": "2021-05-04",
        "certification_date": "2021-05-04",
        "status": "A",
        "authorized_official_last_name": "ELDIN",
        "authorized_official_first_name": "KHALED",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "856-869-8660",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Haddon Township, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.