Healthcare Provider Details

I. General information

NPI: 1659466928
Provider Name (Legal Business Name): DAVID NIDER HAZOURI III DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2117 DATA PARK
HOOVER AL
35244
US

IV. Provider business mailing address

2117 DATA PARK
HOOVER AL
35244
US

V. Phone/Fax

Practice location:
  • Phone: 205-987-8118
  • Fax: 205-444-0460
Mailing address:
  • Phone: 205-987-8118
  • Fax: 205-444-0460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3853
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: