Provider Demographics
NPI:1073358099
Name:RAHMAN, ZAHRA (DMD)
Entity type:Individual
Prefix:DR
First Name:ZAHRA
Middle Name:
Last Name:RAHMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-2902
Mailing Address - Country:US
Mailing Address - Phone:321-947-8656
Mailing Address - Fax:
Practice Address - Street 1:1702 W INTERNATIONAL SPEEDWAY BLVD # 660
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1304
Practice Address - Country:US
Practice Address - Phone:386-252-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN29479122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program