Provider Demographics
NPI:1174945778
Name:KAMILIA DENTAL LLC
Entity type:Organization
Organization Name:KAMILIA DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KAMILIA
Authorized Official - Middle Name:KEMAL
Authorized Official - Last Name:SAID
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-205-3390
Mailing Address - Street 1:1 HARBORSIDE PL
Mailing Address - Street 2:#744
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07311-3908
Mailing Address - Country:US
Mailing Address - Phone:860-205-3390
Mailing Address - Fax:
Practice Address - Street 1:838 HIGH RIDGE RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1913
Practice Address - Country:US
Practice Address - Phone:203-322-5153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT010475261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental