Provider Demographics
NPI:1356368229
Name:BAMEL, JONATHAN STUART (DMD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:STUART
Last Name:BAMEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 WINSTON RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459
Mailing Address - Country:US
Mailing Address - Phone:617-969-1150
Mailing Address - Fax:
Practice Address - Street 1:64 COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:MA
Practice Address - Zip Code:02461
Practice Address - Country:US
Practice Address - Phone:617-965-3225
Practice Address - Fax:617-965-7501
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA154671223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health