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General NPI Number Information
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NPI Number | 1730540949
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Entity Type | Organization
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Legal Business Name | NADER RASSOULI PC
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Dates
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Enumeration Date | 03/15/2016
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Last Update Date | 03/15/2016
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Provider Practice Location Address
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Address Line | 5440 SW WESTGATE DR STE 360
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City | PORTLAND
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State | OR
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Zip | 97221-2446
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Country | US
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Telephone | 503-297-4400
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Fax | 503-297-0684
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Provider Business Mailing Address
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Address Line | 5440 SW WESTGATE DR STE 360
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City | PORTLAND
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State | OR
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Zip | 97221-2446
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Country | US
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Telephone | 503-297-4400
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Fax | 503-297-0684
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Authorized Official
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Title or Position | OWNER
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Name | DR. NADER M RASSOULI
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Credential | DDS, MS
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Telephone | 503-297-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | D6832
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License Number State | OR
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