Jayna Amin, DDS
Individual provider Active NPI General Practice Dentistry · Sycamore, OH
NPI 1821101429 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1821101429
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 30019756 (OH)
- Practice address
- 107 S Sycamore Ave
Sycamore, OH 44882 - Phone
- (419) 927-5562
- Fax
- (491) 927-5563
- NPI assigned
- Aug 16, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160201003040 | OH | Order and Referring Only - Dentist |
7012211790 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30019756 | OH | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 30019756 | OH | Yes |
Addresses
Primary practice location
107 S Sycamore Ave
Sycamore, OH 44882
Mailing address
PO Box 153
Sycamore, OH 44882-0153
Phone (419) 927-5562
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0952296 | Medicaid | OH |
Other providers in Sycamore, OH
- Norman Scott Cisar
- Donald C Fillmore
- Fillmore Pharmacy LLC
- Mackenzie Gatchel
- Robin Darlene Gottfried
All providers in Sycamore, OH · General Practice Dentistry in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.