1023077377 NPI number — DR. ELHAM AMINI DDS PC

Table of content: AMANDA SISSOM (NPI 1407374887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023077377 NPI number — DR. ELHAM AMINI DDS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMINI
Provider First Name:
ELHAM
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS PC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AMIN
Provider Other First Name:
ELHAM
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1023077377
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18121 GEORGIA AVENUE
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
OLNEY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20832
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-570-2100
Provider Business Mailing Address Fax Number:
301-570-3502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18121 GEORGIA AVENUE
Provider Second Line Business Practice Location Address:
LSTE 101
Provider Business Practice Location Address City Name:
OLNEY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-570-2100
Provider Business Practice Location Address Fax Number:
301-570-3502
Provider Enumeration Date:
03/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  0401410525 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 11446 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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