Provider Demographics
NPI:1770697146
Name:NIMER YOUNG, SUE (DMD)
Entity type:Individual
Prefix:DR
First Name:SUE
Middle Name:
Last Name:NIMER YOUNG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5505
Mailing Address - Country:US
Mailing Address - Phone:256-467-6000
Mailing Address - Fax:256-485-4545
Practice Address - Street 1:1907 RAINBOW DR
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5505
Practice Address - Country:US
Practice Address - Phone:256-467-6000
Practice Address - Fax:256-485-4545
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL46551223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL839665OtherUNITED CONCORDIA
AL996722OtherOHS ID NUMBER
AL996722OtherCOMP BENEFITS
AL149156Medicaid
AL009983265Medicaid
AL51136461OtherBCBS
AL51527605OtherBLUE CROSS ID NUMBER
AL529922420Medicaid