Provider Demographics
NPI:1386255354
Name:TIAM, AMIR SAM (DMD)
Entity type:Individual
Prefix:DR
First Name:AMIR
Middle Name:SAM
Last Name:TIAM
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:493 MAIN ST # 495
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:MA
Mailing Address - Zip Code:01450-4254
Mailing Address - Country:US
Mailing Address - Phone:917-922-4640
Mailing Address - Fax:
Practice Address - Street 1:493 MAIN ST # 495
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:MA
Practice Address - Zip Code:01450-4254
Practice Address - Country:US
Practice Address - Phone:917-922-4640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18587831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty