Provider Demographics
NPI:1275003048
Name:AJAY D. AMIN D.D.S. INC.
Entity Type:Organization
Organization Name:AJAY D. AMIN D.D.S. INC.
Other - Org Name:LIGHTHOUSE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:DILIP
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-224-2204
Mailing Address - Street 1:11760 CARMEL CREEK RD APT 305
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-6612
Mailing Address - Country:US
Mailing Address - Phone:951-756-9019
Mailing Address - Fax:
Practice Address - Street 1:3625 MIDWAY DR STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-5253
Practice Address - Country:US
Practice Address - Phone:619-224-2204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-05
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental