Healthcare Provider Details

I. General information

NPI: 1255636155
Provider Name (Legal Business Name): MOHAMED SAMY KAMEL D.M.D, M.S., M.S.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2011
Last Update Date: 04/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 BERGEN ST
NEWARK NJ
07103-2495
US

IV. Provider business mailing address

33 SUMMIT ST
WEST ORANGE NJ
07052-1501
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-4615
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number22DI02546200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: