Healthcare Provider Details

I. General information

NPI: 1992197305
Provider Name (Legal Business Name): RIZWAN AHMAD DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2015
Last Update Date: 02/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 MARKET ST
GAITHERSBURG MD
20878-5461
US

IV. Provider business mailing address

115 MARKET ST
GAITHERSBURG MD
20878-5461
US

V. Phone/Fax

Practice location:
  • Phone: 301-777-7700
  • Fax: 301-777-7710
Mailing address:
  • Phone: 301-777-7700
  • Fax: 301-777-7710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14393
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number12387
License Number StateMD

VIII. Authorized Official

Name: DR. RIZWAN AHMAD
Title or Position: OWNER
Credential: DDS
Phone: 301-777-7700