Provider Demographics
NPI:1376822031
Name:AMINOSHARIAE, AMIR REZA (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMIR
Middle Name:REZA
Last Name:AMINOSHARIAE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:AMIR
Other - Middle Name:
Other - Last Name:AMINOSHARIAE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD MS MSD
Mailing Address - Street 1:1515 W CORNWALLIS DR STE 105
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-6334
Mailing Address - Country:US
Mailing Address - Phone:336-379-1134
Mailing Address - Fax:336-379-1119
Practice Address - Street 1:2956 SPARROW DR
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-2322
Practice Address - Country:US
Practice Address - Phone:216-533-6880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30023530122300000X
CA1035661223X0400X
NC96391223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist