Healthcare Provider Details

I. General information

NPI: 1063027407
Provider Name (Legal Business Name): JIMMY NAZIH SULIMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2020
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WAHOO AVE
GROTON CT
06349-2324
US

IV. Provider business mailing address

702 PLEASANT VALLEY RD N APT 101
GROTON CT
06340-2554
US

V. Phone/Fax

Practice location:
  • Phone: 860-694-3738
  • Fax:
Mailing address:
  • Phone: 209-817-1929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number105509
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: