MEDICARE: DR. MOHAMMAD WAHEDUR RAHMAN D.D.S

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	046388	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700924362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMMAD WAHEDUR RAHMAN D.D.S

Provider Business Mailing Address
First Line	:	25618 HILLSIDE AVE
Second Line	:
City	:	FLORAL PARK
State	:	NY
Zip	:	11004-1618
Country	:	US
Telephone Number	:	718-343-5353
Fax Number	:	718-343-5354

Provider Business Practice Location Address
First Line	:	1749 GRAND CONCOURSE
Second Line	:	1E
City	:	BRONX
State	:	NY
Zip	:	10453-8241
Country	:	US
Telephone Number	:	718-466-2222
Fax Number	:	718-466-6555

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	05/19/2016

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