Healthcare Provider Details

I. General information

NPI: 1447429279
Provider Name (Legal Business Name): ISHITA RAHMAN DMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 RIDGELY AVE STE 20
ANNAPOLIS MD
21401-1409
US

IV. Provider business mailing address

101 RIDGELY AVE STE 20
ANNAPOLIS MD
21401-1409
US

V. Phone/Fax

Practice location:
  • Phone: 410-263-3700
  • Fax: 410-268-4925
Mailing address:
  • Phone: 410-263-3700
  • Fax: 410-268-4925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. MARY DODSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 410-263-3700