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Organization
ELKEDWANI DENTAL CORPORATION
Active
Organization
ELKEDWANI DENTAL CORPORATION
Active
Other names
Legacy Dental of Riverside
Organization subpart
No
Provider details
NPI number
Authorized official
MARK ELKEDWANI (CHIEF CLINICAL OFFICER)
(661) 264-8638
Entity
Organization
Contact information
Practice address
11695 SLATE AVE STE 100, RIVERSIDE, CA 92505-5195
(661) 264-8638
Mailing address
11695 SLATE AVE STE 100, RIVERSIDE, CA 92505-5195
(661) 264-8638
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/28/2026
Last updated
05/28/2026
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