Provider Demographics
NPI:1508803107
Name:AMIN., KAMLESH G (DDS)
Entity Type:Individual
Prefix:MR
First Name:KAMLESH
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 1:3034 W DEVON AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659
Mailing Address - Country:US
Mailing Address - Phone:773-262-5004
Mailing Address - Fax:773-262-6752
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
Practice Address - Country:US
Practice Address - Phone:773-262-5004
Practice Address - Fax:773-262-6752
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190188741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice