Provider Demographics
NPI:1457788200
Name:BASSAM JAMOUS,LLC
Entity Type:Organization
Organization Name:BASSAM JAMOUS,LLC
Other - Org Name:PLEASANT PERIODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BASSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:EL-JAMOUS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-688-5646
Mailing Address - Street 1:126A PLEASANT VALLEY ST
Mailing Address - Street 2:SUITE 1,2
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-7217
Mailing Address - Country:US
Mailing Address - Phone:978-688-5646
Mailing Address - Fax:978-688-5647
Practice Address - Street 1:126A PLEASANT VALLEY ST
Practice Address - Street 2:SUITE 1,2
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-7217
Practice Address - Country:US
Practice Address - Phone:978-688-5646
Practice Address - Fax:978-688-5647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219221223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty