Provider Demographics
NPI:1053930776
Name:KAMARI, JEREMY
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:KAMARI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 S COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7450
Mailing Address - Country:US
Mailing Address - Phone:919-537-3576
Mailing Address - Fax:919-537-3586
Practice Address - Street 1:228 GREAT RD
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:MA
Practice Address - Zip Code:01464-2216
Practice Address - Country:US
Practice Address - Phone:978-344-2264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18590151223G0001X
NC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program