MEDICARE: DR. NIDA FAZAL RAHEMAN

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	1223G0001X	General Practice Dentistry	38544	TX

General Provider Information

NPI Number	:	1629799044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NIDA FAZAL RAHEMAN

Provider Business Mailing Address
First Line	:	3005 WARM SPRINGS LN
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75082-3451
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	925 N BRYAN BELT LINE RD STE 106
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75149-2541
Country	:	US
Telephone Number	:	972-288-3200
Fax Number	:

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

Provider Enumeration Date	:	09/05/2022
Last Update Date	:	09/05/2022

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