Healthcare Provider Details

I. General information

NPI: 1740970615
Provider Name (Legal Business Name): AMINA HAJRO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2023
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 S 5TH ST STE 103
SAINT CHARLES MO
63303-4127
US

IV. Provider business mailing address

3933 N CLARENDON AVE APT 303
CHICAGO IL
60613-3201
US

V. Phone/Fax

Practice location:
  • Phone: 636-837-1966
  • Fax:
Mailing address:
  • Phone: 773-656-1222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2026023606
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: