Provider Demographics
NPI:1205150190
Name:NIZAM, SAMI A II (MD, DMD)
Entity type:Individual
Prefix:DR
First Name:SAMI
Middle Name:A
Last Name:NIZAM
Suffix:II
Gender:M
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4590 WOODMERE BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2918
Mailing Address - Country:US
Mailing Address - Phone:334-271-2002
Mailing Address - Fax:
Practice Address - Street 1:4590 WOODMERE BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106
Practice Address - Country:US
Practice Address - Phone:334-271-2002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-21
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02509400122300000X
AR4193204E00000X
ARE-10461208200000X
AL6484C204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No122300000XDental ProvidersDentist
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery