Healthcare Provider Details

I. General information

NPI: 1417545815
Provider Name (Legal Business Name): RAHMAN DENTAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2021
Last Update Date: 01/02/2021
Certification Date: 01/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30050 HOOVER RD STE D
WARREN MI
48093-2544
US

IV. Provider business mailing address

30050 HOOVER RD STE D
WARREN MI
48093-2544
US

V. Phone/Fax

Practice location:
  • Phone: 248-212-1724
  • Fax:
Mailing address:
  • Phone: 248-212-1724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. KAUSAR RAHMAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 248-212-1724