Provider Demographics
NPI:1316472434
Name:AMIN, PRATIKSHA (DMD, MPH)
Entity type:Individual
Prefix:
First Name:PRATIKSHA
Middle Name:
Last Name:AMIN
Suffix:
Gender:F
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12110 MURPHY RD STE A
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-2407
Mailing Address - Country:US
Mailing Address - Phone:832-689-0328
Mailing Address - Fax:
Practice Address - Street 1:12110 MURPHY RD STE A
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-2407
Practice Address - Country:US
Practice Address - Phone:281-495-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS041186122300000X
TX35856122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist