Provider Demographics
NPI:1184052045
Name:AMIN, VIVEK M (DMD)
Entity type:Individual
Prefix:DR
First Name:VIVEK
Middle Name:M
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 1:21875 THREE NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20653-1564
Mailing Address - Country:US
Mailing Address - Phone:301-863-7077
Mailing Address - Fax:
Practice Address - Street 1:21875 THREE NOTCH RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:20653-1564
Practice Address - Country:US
Practice Address - Phone:301-863-7077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10646122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist