Provider Demographics
NPI:1619536562
Name:AMIN, ANKIT MAHATTEJ (DMD)
Entity Type:Individual
Prefix:
First Name:ANKIT
Middle Name:MAHATTEJ
Last Name:AMIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10832 BLUE HERON DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-4618
Mailing Address - Country:US
Mailing Address - Phone:704-359-7365
Mailing Address - Fax:
Practice Address - Street 1:354 GEORGE W LILES PKWY NW STE 10
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-2404
Practice Address - Country:US
Practice Address - Phone:704-359-7365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11382122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist