1366567760 NPI number — SHINY DENTAL PRAC.

Table of content: (NPI 1366567760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366567760 NPI number — SHINY DENTAL PRAC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHINY DENTAL PRAC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AMINI DENTAL CORP.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366567760
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1916 N TUSTIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92865-4644
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-282-9966
Provider Business Mailing Address Fax Number:
714-282-9969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1916 N TUSTIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92865-4644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-282-9966
Provider Business Practice Location Address Fax Number:
714-282-9969
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AMINI
Authorized Official First Name:
MOHAMMAD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER DENTIST
Authorized Official Telephone Number:
714-282-9966

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: B4703201 . This is a "HEALTHY FAMILY-HFP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 779531 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: G9286101 . This is a "DENTICAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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