Provider Demographics
NPI:1659752137
Name:AMIN, AJAY D (DDS)
Entity Type:Individual
Prefix:
First Name:AJAY
Middle Name:D
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 1:11760 CARMEL CREEK RD APT 305
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-6612
Mailing Address - Country:US
Mailing Address - Phone:951-756-9019
Mailing Address - Fax:
Practice Address - Street 1:3625 MIDWAY DR STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-5253
Practice Address - Country:US
Practice Address - Phone:619-224-2204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-10
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 606664761223G0001X
CA1000641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice