Healthcare Provider Details

I. General information

NPI: 1184784357
Provider Name (Legal Business Name): BAMI DENTAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 1ST ST
HACKENSACK NJ
07601-3411
US

IV. Provider business mailing address

248 1ST ST
HACKENSACK NJ
07601-3411
US

V. Phone/Fax

Practice location:
  • Phone: 201-883-1886
  • Fax: 201-883-1890
Mailing address:
  • Phone: 201-883-1886
  • Fax: 201-883-1890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDI20512
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JUDITH MAMAH
Title or Position: PRESIDENT
Credential: DMD
Phone: 201-883-1886