Provider Demographics
NPI:1316106669
Name:CLINTONVILLE FAMILY DENTISTRY, SHIRIN AMINI DDS, INC
Entity type:Organization
Organization Name:CLINTONVILLE FAMILY DENTISTRY, SHIRIN AMINI DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMINI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-261-8700
Mailing Address - Street 1:4425 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-2612
Mailing Address - Country:US
Mailing Address - Phone:614-261-8700
Mailing Address - Fax:614-261-8705
Practice Address - Street 1:4425 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-2612
Practice Address - Country:US
Practice Address - Phone:614-261-8700
Practice Address - Fax:614-261-8705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH199181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2414275Medicaid