=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730846874
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JULIE R. SAMS, DMD, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2021
-----------------------------------------------------
Last Update Date | 11/23/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 724 ALABAMA AVE
-----------------------------------------------------
City | SELMA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36701-4622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-872-6277
-----------------------------------------------------
Fax | 334-872-6701
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 994
-----------------------------------------------------
City | SELMA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36702-0994
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-872-6277
-----------------------------------------------------
Fax | 334-872-6701
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JULIE SAMS
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 334-375-2590
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------