Basic Information
| Provider Information | |||||||||
| NPI: | 1013205921 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAHEEM | ||||||||
| FirstName: | AISHA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1090 NORTHCHASE PKWY SE STE 290 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300676402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709165352 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 70 WORCESTER RD | ||||||||
| Address2: | |||||||||
| City: | WEBSTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015702158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5186046040 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2011 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 15005 | MD | N | Dental Providers | Dentist | General Practice | 1223G0001X | DN1857739 | MA | Y | Dental Providers | Dentist | General Practice |
No ID Information.