Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 0401417797 | MD |
NPI | 1063166742 |
---|---|
Provider Name | Dr. Sammy Gurman |
First Address | Aurora, CO 80011-7071 |
Second Address | Fairfax, VA 22030-1740 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2022 |
Last Update Date | 10/02/2022 |