Provider Demographics
NPI:1750551537
Name:JAMIL EL SAMNA DDS
Entity type:Organization
Organization Name:JAMIL EL SAMNA DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:EL SAMNA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-868-2747
Mailing Address - Street 1:8407 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-4338
Mailing Address - Country:US
Mailing Address - Phone:201-868-2747
Mailing Address - Fax:201-295-8475
Practice Address - Street 1:8407 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-4338
Practice Address - Country:US
Practice Address - Phone:201-868-2747
Practice Address - Fax:201-295-8475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01658300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2149109Medicaid