Provider Demographics
NPI:1306282769
Name:AMINOV, SANETTA (DDS)
Entity type:Individual
Prefix:DR
First Name:SANETTA
Middle Name:
Last Name:AMINOV
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9919 66TH RD
Mailing Address - Street 2:APT #3A
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4458
Mailing Address - Country:US
Mailing Address - Phone:917-864-2196
Mailing Address - Fax:
Practice Address - Street 1:9919 66TH RD
Practice Address - Street 2:APT #3A
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4458
Practice Address - Country:US
Practice Address - Phone:917-864-2196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0109391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice