Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 22DI02509400 | NJ |
N | 204E00000X | Oral & Maxillofacial Surgeon | 4193 | AR |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 6484C | AL |
N | 208200000X | Surgeon | E-10461 | AR |
N | 208600000X | Surgeon | E-10461 | AR |
NPI | 1205150190 |
---|---|
Provider Name | Dr. Sami A Nizam II |
First Address | Montgomery, AL 36106-2918 |
Second Address | Montgomery, AL 36106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2010 |
Last Update Date | 30/07/2018 |