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General NPI Number Information
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NPI Number | 1245899343
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Entity Type | Organization
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Legal Business Name | SHAMIM AMIN DENTAL PLLC
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Dates
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Enumeration Date | 06/12/2019
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Last Update Date | 06/21/2023
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Provider Practice Location Address
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Address Line | 5203 BROADWAY ST
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City | QUINCY
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State | IL
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Zip | 62305-9110
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Country | US
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Telephone | 217-577-2400
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 70887
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City | CLEVELAND
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State | OH
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Zip | 44190-3189
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHAMIM AMIN
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Credential |
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Telephone | 315-454-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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