Provider Demographics
NPI:1346258597
Name:RAHMAN, SHEIKH MD MATIUR (DDS)
Entity Type:Individual
Prefix:
First Name:SHEIKH
Middle Name:MD MATIUR
Last Name:RAHMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7207 35TH AVE
Mailing Address - Street 2:FIRST-FLOOR
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-4005
Mailing Address - Country:US
Mailing Address - Phone:718-476-3666
Mailing Address - Fax:718-478-4580
Practice Address - Street 1:7207 35TH AVE
Practice Address - Street 2:FIRST-FLOOR
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-4005
Practice Address - Country:US
Practice Address - Phone:718-476-3666
Practice Address - Fax:718-478-4580
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0506801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02405278Medicaid