Provider Demographics
NPI:1396762340
Name:EL SAMNA, JAMIL I (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMIL
Middle Name:I
Last Name:EL SAMNA
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 1:8407 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-4338
Mailing Address - Country:US
Mailing Address - Phone:201-868-2747
Mailing Address - Fax:201-295-8475
Practice Address - Street 1:8407 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-4338
Practice Address - Country:US
Practice Address - Phone:201-868-2747
Practice Address - Fax:201-295-8475
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ165831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2141909Medicaid