Provider Demographics
NPI:1689368706
Name:JAMEEL, ESSRA (DDS)
Entity Type:Individual
Prefix:
First Name:ESSRA
Middle Name:
Last Name:JAMEEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ESSRA
Other - Middle Name:NURIE
Other - Last Name:ABDULLAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25590 PROSPECT AVE APT 47D
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3156
Mailing Address - Country:US
Mailing Address - Phone:909-582-9068
Mailing Address - Fax:
Practice Address - Street 1:34488 YUCAIPA BLVD STE A
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-2482
Practice Address - Country:US
Practice Address - Phone:909-801-8154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA109245122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program