Provider Demographics
NPI:1083846935
Name:MAKHMALBAF, RAHELEH (DMD)
Entity Type:Individual
Prefix:
First Name:RAHELEH
Middle Name:
Last Name:MAKHMALBAF
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 1:9093 RIDGEFIELD DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-6710
Mailing Address - Country:US
Mailing Address - Phone:301-624-1001
Mailing Address - Fax:
Practice Address - Street 1:9093 RIDGEFIELD DR
Practice Address - Street 2:SUITE 203
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6710
Practice Address - Country:US
Practice Address - Phone:301-624-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD146031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice