Provider Demographics
NPI:1205314309
Name:AMIN, SHIVANGI B (DDS)
Entity type:Individual
Prefix:
First Name:SHIVANGI
Middle Name:B
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 1:2801 MCRAE RD STE C1
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-3056
Mailing Address - Country:US
Mailing Address - Phone:804-272-9079
Mailing Address - Fax:804-272-9107
Practice Address - Street 1:2420 OLD BRICK RD APT 1315
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-5995
Practice Address - Country:US
Practice Address - Phone:408-466-5157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014158761223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty