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General NPI Number Information
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NPI Number | 1205150190
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Entity Type | Individual
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Provider Name | SAMI A NIZAM II MD, DMD
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Gender | Male
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Dates
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Enumeration Date | 03/21/2010
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Last Update Date | 07/30/2018
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Provider Practice Location Address
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Address Line | 4590 WOODMERE BLVD
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City | MONTGOMERY
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State | AL
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Zip | 36106
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Country | US
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Telephone | 334-271-2002
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Fax |
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Provider Business Mailing Address
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Address Line | 4590 WOODMERE BLVD
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City | MONTGOMERY
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State | AL
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Zip | 36106-2918
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Country | US
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Telephone | 334-271-2002
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02509400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 4193
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | E-10461
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License Number State | AR
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Taxonomy #4
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 6484C
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License Number State | AL
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