Provider Demographics
NPI:1740301167
Name:RAHIM, MOURAD (DMD)
Entity type:Individual
Prefix:DR
First Name:MOURAD
Middle Name:
Last Name:RAHIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 BEACH ST
Mailing Address - Street 2:BLDG. D
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2717
Mailing Address - Country:US
Mailing Address - Phone:401-596-7707
Mailing Address - Fax:401-596-3645
Practice Address - Street 1:85 BEACH ST
Practice Address - Street 2:BLDG. D
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2717
Practice Address - Country:US
Practice Address - Phone:401-596-7707
Practice Address - Fax:401-596-3645
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN02947 RI1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice