Provider Demographics
NPI:1790141356
Name:AGADZHANOV AMINOV DENTAL
Entity Type:Organization
Organization Name:AGADZHANOV AMINOV DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DMITRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:AMINOV
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:949-935-4457
Mailing Address - Street 1:2200 W OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-2626
Mailing Address - Country:US
Mailing Address - Phone:818-846-2266
Mailing Address - Fax:818-846-2539
Practice Address - Street 1:2200 W OLIVE AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-2626
Practice Address - Country:US
Practice Address - Phone:818-846-2266
Practice Address - Fax:818-846-2539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA558891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty