=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912453648
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RSOOD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2016
-----------------------------------------------------
Last Update Date | 09/01/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5310 KENILWORTH AVE
-----------------------------------------------------
City | RIVERDALE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20737-1234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-277-1214
-----------------------------------------------------
Fax | 301-277-1270
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5310 KENILWORTH AVE
-----------------------------------------------------
City | RIVERDALE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-277-1214
-----------------------------------------------------
Fax | 301-277-1270
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RAHAT SOOD
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 301-277-1214
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 16109
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------