Healthcare Provider Details

I. General information

NPI: 1497850986
Provider Name (Legal Business Name): RAHUL R. AMIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 N MAIN ST
BROOKLYN MI
49230-8977
US

IV. Provider business mailing address

418 N MAIN ST
BROOKLYN MI
49230-8977
US

V. Phone/Fax

Practice location:
  • Phone: 517-592-8422
  • Fax: 517-592-8424
Mailing address:
  • Phone: 517-592-8422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901018416
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: