Provider Demographics
NPI:1821101429
Name:AMIN, JAYNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAYNA
Middle Name:
Last Name:AMIN
Suffix:
Gender:F
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:PO BOX 153
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:OH
Mailing Address - Zip Code:44882-0153
Mailing Address - Country:US
Mailing Address - Phone:419-927-5562
Mailing Address - Fax:419-927-5563
Practice Address - Street 1:107 S SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:OH
Practice Address - Zip Code:44882
Practice Address - Country:US
Practice Address - Phone:419-927-5562
Practice Address - Fax:491-927-5563
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300197561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0952296Medicaid