Provider Demographics
NPI:1194194084
Name:ANITHA ABDULRAHIMAN, FNU (DMD)
Entity Type:Individual
Prefix:
First Name:FNU
Middle Name:
Last Name:ANITHA ABDULRAHIMAN
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 1:75 GILCREAST RD UNIT 108
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3565
Mailing Address - Country:US
Mailing Address - Phone:267-253-1254
Mailing Address - Fax:
Practice Address - Street 1:75 GILCREAST RD UNIT 108
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3565
Practice Address - Country:US
Practice Address - Phone:267-253-1254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1857068122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist