Healthcare Provider Details

I. General information

NPI: 1730540949
Provider Name (Legal Business Name): NADER RASSOULI PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2016
Last Update Date: 03/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5440 SW WESTGATE DR STE 360
PORTLAND OR
97221-2446
US

IV. Provider business mailing address

5440 SW WESTGATE DR STE 360
PORTLAND OR
97221-2446
US

V. Phone/Fax

Practice location:
  • Phone: 503-297-4400
  • Fax: 503-297-0684
Mailing address:
  • Phone: 503-297-4400
  • Fax: 503-297-0684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberD6832
License Number StateOR

VIII. Authorized Official

Name: DR. NADER M RASSOULI
Title or Position: OWNER
Credential: DDS, MS
Phone: 503-297-4400