Provider Demographics
NPI:1487093464
Name:AMIN, ANUSHKA (DMD)
Entity type:Individual
Prefix:DR
First Name:ANUSHKA
Middle Name:
Last Name:AMIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 HARDIN ST SW
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-5311
Mailing Address - Country:US
Mailing Address - Phone:770-922-0511
Mailing Address - Fax:
Practice Address - Street 1:1115 HARDIN ST SW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-5311
Practice Address - Country:US
Practice Address - Phone:770-922-0511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-23
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0146081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice