Healthcare Provider Details

I. General information

NPI: 1437370079
Provider Name (Legal Business Name): ABBAS RAISSI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2581 SAMARITAN DR., SUITE 110
SAN JOSE CA
95124
US

IV. Provider business mailing address

2581 SAMARITAN DR., SUITE 110
SAN JOSE CA
95124
US

V. Phone/Fax

Practice location:
  • Phone: 408-358-8777
  • Fax: 408-358-3377
Mailing address:
  • Phone: 408-358-8777
  • Fax: 408-358-3377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number47162
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: