Provider Demographics
NPI:1366772717
Name:RAHMAN, KAUSAR (DDS)
Entity type:Individual
Prefix:DR
First Name:KAUSAR
Middle Name:
Last Name:RAHMAN
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 1:1141 FOXBORO
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5460
Mailing Address - Country:US
Mailing Address - Phone:248-212-1724
Mailing Address - Fax:
Practice Address - Street 1:7900 KERCHEVAL ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-2439
Practice Address - Country:US
Practice Address - Phone:313-921-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010199331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice