Provider Demographics
NPI:1497445407
Name:RAHIMI, BENJAMIN
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:RAHIMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8055 RITCHIE HWY STE 102
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-1074
Mailing Address - Country:US
Mailing Address - Phone:410-590-6690
Mailing Address - Fax:410-590-1693
Practice Address - Street 1:8055 RITCHIE HWY STE 102
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-1074
Practice Address - Country:US
Practice Address - Phone:410-590-6690
Practice Address - Fax:410-590-1693
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-11
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD179541223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program