Provider Demographics
NPI:1972796662
Name:EL-JAMOUS, BASSAM S (DMD, MSD, CAGS)
Entity type:Individual
Prefix:DR
First Name:BASSAM
Middle Name:S
Last Name:EL-JAMOUS
Suffix:
Gender:M
Credentials:DMD, MSD, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 JASPER ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-4814
Mailing Address - Country:US
Mailing Address - Phone:617-838-0952
Mailing Address - Fax:
Practice Address - Street 1:555 TURNPIKE ST
Practice Address - Street 2:SUITE 55
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5923
Practice Address - Country:US
Practice Address - Phone:617-838-0952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-25
Last Update Date:2007-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219221223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics