Provider Demographics
NPI:1093705931
Name:RAHMAN, MAHBUBA (DDS)
Entity Type:Individual
Prefix:
First Name:MAHBUBA
Middle Name:
Last Name:RAHMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 PROGRESS ST
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1102
Mailing Address - Country:US
Mailing Address - Phone:908-754-5252
Mailing Address - Fax:908-754-6663
Practice Address - Street 1:3 PROGRESS ST
Practice Address - Street 2:SUITE # 101
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1102
Practice Address - Country:US
Practice Address - Phone:908-754-5252
Practice Address - Fax:908-754-6663
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ19173122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist