Provider Demographics
NPI:1548570948
Name:RAHMAN, FARZANA (DDS, MS)
Entity Type:Individual
Prefix:
First Name:FARZANA
Middle Name:
Last Name:RAHMAN
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6208 FAYETTEVILLE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713
Mailing Address - Country:US
Mailing Address - Phone:919-968-0015
Mailing Address - Fax:919-968-9515
Practice Address - Street 1:6208 FAYETTEVILLE RD STE 105
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713
Practice Address - Country:US
Practice Address - Phone:919-968-0015
Practice Address - Fax:919-968-9515
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC75151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902WKMedicaid