MEDICARE: KAMILIA DENTAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	010475	CT

General Provider Information

NPI Number	:	1174945778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAMILIA DENTAL LLC

Provider Business Mailing Address
First Line	:	1 HARBORSIDE PL
Second Line	:	#744
City	:	JERSEY CITY
State	:	NJ
Zip	:	07311-3908
Country	:	US
Telephone Number	:	860-205-3390
Fax Number	:

Provider Business Practice Location Address
First Line	:	838 HIGH RIDGE RD
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06905-1913
Country	:	US
Telephone Number	:	203-322-5153
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	KAMILIA KEMAL SAID
Credential	:	DMD
Telephone Number	:	860-205-3390

Provider Enumeration Date	:	01/16/2014
Last Update Date	:	01/16/2014

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Directions to “KAMILIA DENTAL LLC ” Practice Location

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