Provider Demographics
NPI:1649868837
Name:RANA, RUPAM (DDS)
Entity type:Individual
Prefix:
First Name:RUPAM
Middle Name:
Last Name:RANA
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 1:15646 ALTON DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-9633
Mailing Address - Country:US
Mailing Address - Phone:239-940-3836
Mailing Address - Fax:
Practice Address - Street 1:3330 FORUM BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-5578
Practice Address - Country:US
Practice Address - Phone:239-241-9128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH27484124Q00000X
FLDN303581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No124Q00000XDental ProvidersDental Hygienist