Provider Demographics
NPI:1679656730
Name:HAMATI, ISAM (DDS)
Entity Type:Individual
Prefix:
First Name:ISAM
Middle Name:
Last Name:HAMATI
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:PO BOX 3189
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13220-3189
Mailing Address - Country:US
Mailing Address - Phone:315-454-6000
Mailing Address - Fax:315-454-8650
Practice Address - Street 1:8057 BREWERTON RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-9585
Practice Address - Country:US
Practice Address - Phone:315-698-0040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010905A122300000X
PADS030266L122300000X
MA21260122300000X
ME3760122300000X
NJ22DI02018700122300000X
VT016-0002234122300000X
NY047142-1122300000X
CT8567122300000X
NH3446122300000X
RIDEN02865122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist