| NPI | 1871085415 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMI ADAM NIZAM Manager 334-271-2002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2018-12-12 |