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General NPI Number Information
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NPI Number | 1144873522
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Entity Type | Individual
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Provider Name | SUSAN JAAMOUR
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Gender | Female
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Dates
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Enumeration Date | 07/24/2019
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Last Update Date | 02/27/2024
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Provider Practice Location Address
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Address Line | 201 4TH ST S UNIT 441
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City | SAINT PETERSBURG
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State | FL
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Zip | 33701-4574
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Country | US
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Telephone | 248-917-2301
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Fax |
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Provider Business Mailing Address
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Address Line | 201 4TH ST S UNIT 441
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City | SAINT PETERSBURG
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State | FL
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Zip | 33701-4574
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Country | US
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Telephone | 248-917-2301
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901600233
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019032316
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN27604
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License Number State | FL
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