Provider Demographics
NPI:1063166742
Name:GURMAN, SAMMY (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMMY
Middle Name:
Last Name:GURMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13650 E COLFAX AVE APT 4321
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-7071
Mailing Address - Country:US
Mailing Address - Phone:240-893-2094
Mailing Address - Fax:
Practice Address - Street 1:9901 FAIRFAX BLVD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-1740
Practice Address - Country:US
Practice Address - Phone:703-383-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04014177971223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics