Provider Demographics
NPI:1083347199
Name:KAMOONA, HUSSEIN (DMD)
Entity Type:Individual
Prefix:
First Name:HUSSEIN
Middle Name:
Last Name:KAMOONA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9245 WOOD GLADE DR
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-2209
Mailing Address - Country:US
Mailing Address - Phone:508-596-1500
Mailing Address - Fax:
Practice Address - Street 1:14679 APPLE HARVEST DR STE 100
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-3703
Practice Address - Country:US
Practice Address - Phone:304-707-9674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WV4598122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program