Provider Demographics
NPI:1225254394
Name:KHAMMAR, ISSAM JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:ISSAM
Middle Name:JOSEPH
Last Name:KHAMMAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-3628
Mailing Address - Country:US
Mailing Address - Phone:609-242-3464
Mailing Address - Fax:609-242-3465
Practice Address - Street 1:123 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-3628
Practice Address - Country:US
Practice Address - Phone:609-242-3464
Practice Address - Fax:609-242-3465
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDO174711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice