Provider Demographics
NPI:1114095593
Name:AMIN, GAURANG G (DDS)
Entity Type:Individual
Prefix:
First Name:GAURANG
Middle Name:G
Last Name:AMIN
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 1:1457 ROSE GLEN DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4004
Mailing Address - Country:US
Mailing Address - Phone:916-248-4041
Mailing Address - Fax:
Practice Address - Street 1:5247 ELKHORN BLVD STE C
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95842-2509
Practice Address - Country:US
Practice Address - Phone:916-344-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54122122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist