Provider Demographics
NPI:1578679429
Name:MAMOUN, JOHN SAMI (DMD, FAGD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SAMI
Last Name:MAMOUN
Suffix:
Gender:M
Credentials:DMD, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CRAIG RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726
Mailing Address - Country:US
Mailing Address - Phone:732-431-2888
Mailing Address - Fax:973-514-1522
Practice Address - Street 1:100 CRAIG RD
Practice Address - Street 2:SUITE 106
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726
Practice Address - Country:US
Practice Address - Phone:732-431-2888
Practice Address - Fax:973-514-1522
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023139001223G0001X
NJ22DI023139011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice