Provider Demographics
NPI:1366567760
Name:SHINY DENTAL PRAC.
Entity type:Organization
Organization Name:SHINY DENTAL PRAC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AMINI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-282-9966
Mailing Address - Street 1:1916 N TUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-4644
Mailing Address - Country:US
Mailing Address - Phone:714-282-9966
Mailing Address - Fax:714-282-9969
Practice Address - Street 1:1916 N TUSTIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-4644
Practice Address - Country:US
Practice Address - Phone:714-282-9966
Practice Address - Fax:714-282-9969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4703201OtherHEALTHY FAMILY-HFP
CA779531OtherUNITED CONCORDIA
CAG9286101OtherDENTICAL