Provider Demographics
NPI:1871563478
Name:KAMEROS, JONATHAN BRUCE (DDS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:BRUCE
Last Name:KAMEROS
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 1:10301 LEFFERTS BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-2011
Mailing Address - Country:US
Mailing Address - Phone:718-848-7756
Mailing Address - Fax:718-848-1860
Practice Address - Street 1:10301 LEFFERTS BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-2011
Practice Address - Country:US
Practice Address - Phone:718-848-7756
Practice Address - Fax:718-848-1860
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0275761223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCIGNAOther8598697004
NYUNITED CONCORDIAOther121771
NY70934OtherAETNA HEALTH CARE
NYDS523OtherOXFORD HEALTH PLANS
NY6070OtherDEL;TA DENTAL
NY6070OtherDEL;TA DENTAL