Provider Demographics
NPI:1922290626
Name:SAMS, JULIE RAVIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:RAVIS
Last Name:SAMS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:RAVIS
Other - Last Name:SAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 994
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36702-0994
Mailing Address - Country:US
Mailing Address - Phone:334-872-6277
Mailing Address - Fax:334-872-6701
Practice Address - Street 1:724 ALABAMA AVE
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-4622
Practice Address - Country:US
Practice Address - Phone:334-872-6277
Practice Address - Fax:334-872-6701
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5422CS1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice