Provider Demographics
NPI:1124477765
Name:AHANOR, ROSEMARY (DDS)
Entity type:Individual
Prefix:DR
First Name:ROSEMARY
Middle Name:
Last Name:AHANOR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 ALABAMA AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-4540
Mailing Address - Country:US
Mailing Address - Phone:202-299-5610
Mailing Address - Fax:
Practice Address - Street 1:11150 SUNSET HILLS RD STE 303
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5335
Practice Address - Country:US
Practice Address - Phone:703-651-6130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-04
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCIN PROCESS122300000X
DC101713122300000X
MD16307122300000X
VA0401416406122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist