Provider Demographics
NPI:1285180216
Name:KAMLESH G AMIN D D S PC
Entity Type:Organization
Organization Name:KAMLESH G AMIN D D S PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMLESH
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-382-1346
Mailing Address - Street 1:3034 W DEVON AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-1455
Mailing Address - Country:US
Mailing Address - Phone:847-382-1346
Mailing Address - Fax:
Practice Address - Street 1:3034 W DEVON AVE
Practice Address - Street 2:STE 200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-1455
Practice Address - Country:US
Practice Address - Phone:847-382-1346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-30
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty