Provider Demographics
NPI:1154485969
Name:JEBREIL, KAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:KAM
Middle Name:
Last Name:JEBREIL
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 1:3870 MISSION AVE STE D4
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-1880
Mailing Address - Country:US
Mailing Address - Phone:760-967-8899
Mailing Address - Fax:
Practice Address - Street 1:3870 MISSION AVE STE D4
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-1880
Practice Address - Country:US
Practice Address - Phone:760-967-8899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33211122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist