Provider Demographics
NPI:1194271445
Name:AMIN, DINA
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:AMIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DINA
Other - Middle Name:
Other - Last Name:MOHAMMADAMEEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1258 DEKALB AVENUE NE
Mailing Address - Street 2:UNITE 108
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307
Mailing Address - Country:US
Mailing Address - Phone:470-421-7024
Mailing Address - Fax:
Practice Address - Street 1:1365 CLIFTON,BUILDING B, ORAL AND MAXILLOFACIAL SURGERY
Practice Address - Street 2:SUITE 2300
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322
Practice Address - Country:US
Practice Address - Phone:205-566-0435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADNF0003931223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery