Provider Demographics
NPI:1720639842
Name:AOMIN, UNKNOWN (DDS)
Entity Type:Individual
Prefix:DR
First Name:UNKNOWN
Middle Name:
Last Name:AOMIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:FNU 'NOMIN'
Other - Middle Name:
Other - Last Name:AOMIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:8489 FISHERS CENTER DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2318
Mailing Address - Country:US
Mailing Address - Phone:317-578-2224
Mailing Address - Fax:317-578-2225
Practice Address - Street 1:8489 FISHERS CENTER DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2318
Practice Address - Country:US
Practice Address - Phone:317-578-2224
Practice Address - Fax:317-578-2225
Is Sole Proprietor?:No
Enumeration Date:2019-09-20
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014167321223E0200X
IN12013289A1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics