Healthcare Provider Details

I. General information

NPI: 1598103277
Provider Name (Legal Business Name): MATTHEW CHARLES NIMMICH D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 GOODYEAR AVE
GADSDEN AL
35903-1107
US

IV. Provider business mailing address

910 GOODYEAR AVE
GADSDEN AL
35903-1107
US

V. Phone/Fax

Practice location:
  • Phone: 256-492-6363
  • Fax: 256-492-0047
Mailing address:
  • Phone: 256-492-6363
  • Fax: 256-492-0047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD.007429-C
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2018
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: