Provider Demographics
NPI:1821788977
Name:RAHAMUT-ALI-SMITH, CHARMAINE ANN (RDH, PHDHP, BS)
Entity Type:Individual
Prefix:MRS
First Name:CHARMAINE
Middle Name:ANN
Last Name:RAHAMUT-ALI-SMITH
Suffix:
Gender:F
Credentials:RDH, PHDHP, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 FIFTH AVE
Mailing Address - Street 2:
Mailing Address - City:MCKEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15132-2631
Mailing Address - Country:US
Mailing Address - Phone:413-209-0719
Mailing Address - Fax:
Practice Address - Street 1:339 FIFTH AVE
Practice Address - Street 2:
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15132-2631
Practice Address - Country:US
Practice Address - Phone:413-209-0719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH006730L124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist