Provider Demographics
NPI:1063845311
Name:AMIN, RADHA (DMD)
Entity Type:Individual
Prefix:DR
First Name:RADHA
Middle Name:
Last Name:AMIN
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 1:1133 W 21ST ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-3321
Mailing Address - Country:US
Mailing Address - Phone:215-237-1068
Mailing Address - Fax:
Practice Address - Street 1:3535 CLEAR LAKE CITY BLVD STE 400
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77059-2508
Practice Address - Country:US
Practice Address - Phone:281-990-0677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX346181223G0001X
PADS039669122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist