Provider Demographics
NPI:1710197439
Name:JETHANI, KAMLESH (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAMLESH
Middle Name:
Last Name:JETHANI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-1200
Mailing Address - Country:US
Mailing Address - Phone:973-427-9299
Mailing Address - Fax:
Practice Address - Street 1:354 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-1200
Practice Address - Country:US
Practice Address - Phone:973-427-9299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02132800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist