Healthcare Provider Details

I. General information

NPI: 1699301986
Provider Name (Legal Business Name): ALON AMINOV DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2020
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9943 64TH RD
REGO PARK NY
11374-2657
US

IV. Provider business mailing address

9943 64TH RD
REGO PARK NY
11374-2657
US

V. Phone/Fax

Practice location:
  • Phone: 646-286-0539
  • Fax:
Mailing address:
  • Phone: 646-286-0539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN25130
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN25130
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number12854
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number061981
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number061981
License Number StateNY
# 6
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12854
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: