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General NPI Number Information
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NPI Number | 1912173196
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Entity Type | Individual
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Provider Name | RAHMAN ULLAH DDS, MSD
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Gender | Male
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Dates
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Enumeration Date | 05/07/2008
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Last Update Date | 02/01/2019
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Provider Practice Location Address
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Address Line | PARK AVE DENTAL CENTER 456 PARK AVENUE
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City | WORCHESTER
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State | MA
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Zip | 01610
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Country | US
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Telephone | 508-799-4555
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Fax |
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Provider Business Mailing Address
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Address Line | 63 SHERMAN ST
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City | CANTON
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State | MA
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Zip | 02021-2225
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Country | US
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Telephone | 617-462-0116
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22086
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | P58401
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN22086
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License Number State | MA
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