Provider Demographics
NPI:1396231460
Name:RAHMAN, MOHAMMED (DDS)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
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 1:220 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-6216
Mailing Address - Country:US
Mailing Address - Phone:973-478-1616
Mailing Address - Fax:973-478-1732
Practice Address - Street 1:220 5TH ST
Practice Address - Street 2:
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-6216
Practice Address - Country:US
Practice Address - Phone:973-478-1616
Practice Address - Fax:973-478-1732
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02717900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist