Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 000047 | NY |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 000047 | NY |
NPI | 1104161223 |
---|---|
Provider Name | Ramtin Sadid Zadeh |
First Address | Birmingham, AL 35249-1900 |
Second Address | Birmingham, AL 35249-1900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2012 |
Last Update Date | 07/07/2021 |