Provider Demographics
NPI:1265106934
Name:AMINOV, REBECCA (DDS)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:AMINOV
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 1:6336 99TH ST
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1979
Mailing Address - Country:US
Mailing Address - Phone:917-331-1800
Mailing Address - Fax:
Practice Address - Street 1:714 STATE ROUTE 10 UNIT 200
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-2059
Practice Address - Country:US
Practice Address - Phone:973-366-8338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2021-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI028463001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics