Provider Demographics
NPI:1750713764
Name:AMIN, AISHA (DMD, MPH)
Entity type:Individual
Prefix:
First Name:AISHA
Middle Name:
Last Name:AMIN
Suffix:
Gender:F
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3138 OLYMPIC RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-8326
Mailing Address - Country:US
Mailing Address - Phone:154-465-4141
Mailing Address - Fax:
Practice Address - Street 1:1141 PEAR TREE LN STE 120
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6485
Practice Address - Country:US
Practice Address - Phone:707-254-1770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA626911223D0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223D0001XDental ProvidersDentistDental Public Health