Provider Demographics
NPI:1992105050
Name:SOOD, RAHAT (DMD)
Entity type:Individual
Prefix:
First Name:RAHAT
Middle Name:
Last Name:SOOD
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 1:5310 KENILWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-3102
Mailing Address - Country:US
Mailing Address - Phone:301-277-1214
Mailing Address - Fax:
Practice Address - Street 1:10215 FERNWOOD RD
Practice Address - Street 2:SUITE 415
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1106
Practice Address - Country:US
Practice Address - Phone:301-493-4204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16109122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist