Provider Demographics
NPI:1811483779
Name:KAMAL, USAMA (DDS)
Entity type:Individual
Prefix:
First Name:USAMA
Middle Name:
Last Name:KAMAL
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 1:7801 PHOENIX AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5091
Mailing Address - Country:US
Mailing Address - Phone:479-452-8650
Mailing Address - Fax:
Practice Address - Street 1:7801 PHOENIX AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5091
Practice Address - Country:US
Practice Address - Phone:479-452-8650
Practice Address - Fax:479-484-0540
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR42971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty