Provider Demographics
NPI:1780358606
Name:ITMAIZA, RABEE (DDS)
Entity type:Individual
Prefix:
First Name:RABEE
Middle Name:
Last Name:ITMAIZA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 DULANEY MILL DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-6227
Mailing Address - Country:US
Mailing Address - Phone:240-409-5010
Mailing Address - Fax:
Practice Address - Street 1:3701 S GEORGE MASON DR UNIT C7N
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-4722
Practice Address - Country:US
Practice Address - Phone:703-998-8826
Practice Address - Fax:703-998-8828
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401417606122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist