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General NPI Number Information
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NPI Number | 1932527314
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Entity Type | Organization
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Legal Business Name | REZAEE DENTAL
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Dates
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Enumeration Date | 04/02/2014
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Last Update Date | 04/02/2014
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Provider Practice Location Address
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Address Line | 2400 WILLAMETTE ST
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City | EUGENE
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State | OR
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Zip | 97405-3131
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Country | US
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Telephone | 541-683-8034
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Fax | 541-485-3134
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Provider Business Mailing Address
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Address Line | 2400 WILLAMETTE ST
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City | EUGENE
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State | OR
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Zip | 97405-3131
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Country | US
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Telephone | 541-683-8034
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Fax | 541-485-3134
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. SHAHRAM REZAEE
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Credential | DMD
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Telephone | 541-683-8034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D7282
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License Number State | OR
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