Provider Demographics
NPI:1912370750
Name:KAMOUNI, WISSAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:WISSAM
Middle Name:
Last Name:KAMOUNI
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 1:1510 S CARMEN ST
Mailing Address - Street 2:UNIT 3323
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606
Mailing Address - Country:US
Mailing Address - Phone:248-326-5247
Mailing Address - Fax:
Practice Address - Street 1:1051 S. DALE MARBY HWY
Practice Address - Street 2:SUITE 101A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629
Practice Address - Country:US
Practice Address - Phone:813-213-3178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010217151223G0001X
FLDN28686122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice