Provider Demographics
NPI:1124687900
Name:JAMMU, KIMPREET (DMD)
Entity type:Individual
Prefix:
First Name:KIMPREET
Middle Name:
Last Name:JAMMU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 ROUTE 47
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08242-1406
Mailing Address - Country:US
Mailing Address - Phone:516-776-5516
Mailing Address - Fax:
Practice Address - Street 1:1708 ROUTE 47
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:NJ
Practice Address - Zip Code:08242-1406
Practice Address - Country:US
Practice Address - Phone:516-776-5516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D102839100122300000X
CT12559122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist