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General NPI Number Information
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NPI Number | 1457788200
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Entity Type | Organization
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Legal Business Name | BASSAM JAMOUS,LLC
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Dates
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Enumeration Date | 10/10/2013
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Last Update Date | 10/18/2013
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Provider Practice Location Address
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Address Line | 126A PLEASANT VALLEY ST SUITE 1,2
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City | METHUEN
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State | MA
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Zip | 01844-7217
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Country | US
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Telephone | 978-688-5646
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Fax | 978-688-5647
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Provider Business Mailing Address
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Address Line | 126A PLEASANT VALLEY ST SUITE 1,2
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City | METHUEN
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State | MA
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Zip | 01844-7217
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Country | US
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Telephone | 978-688-5646
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Fax | 978-688-5647
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Authorized Official
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Title or Position | PERIODONTIST
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Name | DR. BASSAM EL-JAMOUS
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Credential | DMD
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Telephone | 978-688-5646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 21922
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License Number State | MA
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