Provider Demographics
NPI:1538483623
Name:M.J. AMINI DENTAL CORP.
Entity Type:Organization
Organization Name:M.J. AMINI DENTAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:AMINI DETNAL CORPORATION
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-547-4444
Mailing Address - Street 1:PO BOX #6398
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706
Mailing Address - Country:US
Mailing Address - Phone:714-547-4444
Mailing Address - Fax:714-547-4433
Practice Address - Street 1:2001 WEST 17TH STREET
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706
Practice Address - Country:US
Practice Address - Phone:714-547-4444
Practice Address - Fax:714-547-4433
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:M.J. AMINI DENTAL CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA470321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty