MEDICARE: DR. RADHA AMIN D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	34618	TX
2	122300000X	Dentist	DS039669	PA

General Provider Information

NPI Number	:	1063845311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RADHA AMIN D.M.D.

Provider Business Mailing Address
First Line	:	1133 W 21ST ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-3321
Country	:	US
Telephone Number	:	215-237-1068
Fax Number	:

Provider Business Practice Location Address
First Line	:	3535 CLEAR LAKE CITY BLVD STE 400
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77059-2508
Country	:	US
Telephone Number	:	281-990-0677
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2013
Last Update Date	:	10/05/2021

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