Provider Demographics
NPI:1831222611
Name:AMINI DENTAL CORPORATION
Entity type:Organization
Organization Name:AMINI DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AMINI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-282-9966
Mailing Address - Street 1:1916 N TUSTIN AVE.
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865
Mailing Address - Country:US
Mailing Address - Phone:714-282-9966
Mailing Address - Fax:714-282-9969
Practice Address - Street 1:1916 N TUSTIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865
Practice Address - Country:US
Practice Address - Phone:714-282-9966
Practice Address - Fax:714-282-9969
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMINI DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-13
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223G0001X
CA470321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92861-01OtherDENTI-CAL