Provider Demographics
NPI:1083800296
Name:AMINOV, DMITRY G
Entity Type:Individual
Prefix:
First Name:DMITRY
Middle Name:G
Last Name:AMINOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2780 TAPO CANYON RD A1B
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-6837
Mailing Address - Country:US
Mailing Address - Phone:805-520-1711
Mailing Address - Fax:805-520-1511
Practice Address - Street 1:2780 TAPO CANYON RD
Practice Address - Street 2:A-1B
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-6840
Practice Address - Country:US
Practice Address - Phone:805-520-1711
Practice Address - Fax:805-520-1511
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55889122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist