Provider Demographics
NPI:1790301554
Name:NIZAMI, SHAYAN ASLAM (DMD)
Entity Type:Individual
Prefix:
First Name:SHAYAN
Middle Name:ASLAM
Last Name:NIZAMI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 SHEILA AVE
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-3797
Mailing Address - Country:US
Mailing Address - Phone:469-358-2307
Mailing Address - Fax:
Practice Address - Street 1:3330 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-2717
Practice Address - Country:US
Practice Address - Phone:214-780-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36179122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist