Provider Demographics
NPI:1023077377
Name:AMINI, ELHAM (DDS PC)
Entity type:Individual
Prefix:DR
First Name:ELHAM
Middle Name:
Last Name:AMINI
Suffix:
Gender:F
Credentials:DDS PC
Other - Prefix:
Other - First Name:ELHAM
Other - Middle Name:
Other - Last Name:AMIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:18121 GEORGIA AVENUE
Mailing Address - Street 2:STE 101
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832
Mailing Address - Country:US
Mailing Address - Phone:301-570-2100
Mailing Address - Fax:301-570-3502
Practice Address - Street 1:18121 GEORGIA AVENUE
Practice Address - Street 2:LSTE 101
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832
Practice Address - Country:US
Practice Address - Phone:301-570-2100
Practice Address - Fax:301-570-3502
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410525122300000X
MD11446122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist