Healthcare Provider Details

I. General information

NPI: 1467527572
Provider Name (Legal Business Name): JONATHAN M KAMEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 WALWORTH AVE
SCARSDALE NY
10583-1431
US

IV. Provider business mailing address

45 WALWORTH AVE
SCARSDALE NY
10583-1431
US

V. Phone/Fax

Practice location:
  • Phone: 914-262-1398
  • Fax: 212-677-1907
Mailing address:
  • Phone: 914-262-1398
  • Fax: 914-725-1442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number029633
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: