MEDICARE: SURAIYA RAHMAN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	55143	CA

General Provider Information

NPI Number	:	1477608537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SURAIYA RAHMAN DMD

Provider Business Mailing Address
First Line	:	2956 E EL PASO AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-6412
Country	:	US
Telephone Number	:	559-299-6015
Fax Number	:

Provider Business Practice Location Address
First Line	:	2956 E EL PASO AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-6412
Country	:	US
Telephone Number	:	559-299-6015
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	07/08/2007

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