Provider Demographics
NPI:1497875397
Name:TAHA, ESSAM KAMAL (DMD MS)
Entity Type:Individual
Prefix:DR
First Name:ESSAM
Middle Name:KAMAL
Last Name:TAHA
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:871 BALTIMORE PIKE
Mailing Address - Street 2:REGENCY PLAZA SUITE 21
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342
Mailing Address - Country:US
Mailing Address - Phone:610-558-3505
Mailing Address - Fax:610-558-3575
Practice Address - Street 1:871 BALTIMORE PIKE
Practice Address - Street 2:REGENCY PLAZA SUITE 21
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342
Practice Address - Country:US
Practice Address - Phone:610-558-3505
Practice Address - Fax:610-558-3575
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029161L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist