Provider Demographics
NPI:1679837546
Name:RASUL, AFIA (DDS)
Entity Type:Individual
Prefix:
First Name:AFIA
Middle Name:
Last Name:RASUL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2288 BLUE WATER BLVD
Mailing Address - Street 2:SUITE 420
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-3309
Mailing Address - Country:US
Mailing Address - Phone:410-672-0000
Mailing Address - Fax:443-645-0214
Practice Address - Street 1:2288 BLUE WATER BLVD
Practice Address - Street 2:SUITE 420
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-3309
Practice Address - Country:US
Practice Address - Phone:410-672-0000
Practice Address - Fax:443-645-0214
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD150261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice