Provider Demographics
NPI:1215078563
Name:ADVANCED AESTHETIC DENTISTRY, PC
Entity type:Organization
Organization Name:ADVANCED AESTHETIC DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOURAD
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:401-596-7707
Mailing Address - Street 1:85 BEACH ST
Mailing Address - Street 2:BLDG. D
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2717
Mailing Address - Country:US
Mailing Address - Phone:401-596-7707
Mailing Address - Fax:401-596-3645
Practice Address - Street 1:85 BEACH ST
Practice Address - Street 2:BLDG. D
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2717
Practice Address - Country:US
Practice Address - Phone:401-596-7707
Practice Address - Fax:401-596-3645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN029471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty