Provider Demographics
NPI:1356993919
Name:AMIN, SUMMAR SAMI (DDS)
Entity type:Individual
Prefix:DR
First Name:SUMMAR
Middle Name:SAMI
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 1:1901 E 1ST ST APT 234
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-4057
Mailing Address - Country:US
Mailing Address - Phone:424-333-2714
Mailing Address - Fax:
Practice Address - Street 1:5731 E SANTA ANA CANYON RD STE A
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-3234
Practice Address - Country:US
Practice Address - Phone:714-998-2956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-14
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS105047122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist