Provider Demographics
NPI:1215215264
Name:KHAMIS, SERAG IBRAHIM (DMD)
Entity Type:Individual
Prefix:DR
First Name:SERAG
Middle Name:IBRAHIM
Last Name:KHAMIS
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 1:930 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2723
Mailing Address - Country:US
Mailing Address - Phone:201-696-1802
Mailing Address - Fax:
Practice Address - Street 1:301 HAZEL ST
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2812
Practice Address - Country:US
Practice Address - Phone:973-246-5177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02476000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist