Provider Demographics
NPI:1225110356
Name:RAHMAN, AYESHA (DMD)
Entity Type:Individual
Prefix:DR
First Name:AYESHA
Middle Name:
Last Name:RAHMAN
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 1:121 MARBLE MILL RD NW STE 201
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7959
Mailing Address - Country:US
Mailing Address - Phone:770-427-8579
Mailing Address - Fax:770-427-8957
Practice Address - Street 1:121 MARBLE MILL RD NW STE 201
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7959
Practice Address - Country:US
Practice Address - Phone:770-427-8579
Practice Address - Fax:770-427-8957
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0126961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice