Healthcare Provider Details

I. General information

NPI: 1891489753
Provider Name (Legal Business Name): AMIR SIADAT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 SNOW ST
OXFORD AL
36203-1266
US

IV. Provider business mailing address

420 SNOW ST
OXFORD AL
36203-1266
US

V. Phone/Fax

Practice location:
  • Phone: 256-831-3432
  • Fax:
Mailing address:
  • Phone: 256-831-3432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD.007275-C1
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: