Provider Demographics
NPI:1013579192
Name:RASSOUL, AMEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMEL
Middle Name:
Last Name:RASSOUL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 RALEIGH ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-4120
Mailing Address - Country:US
Mailing Address - Phone:514-962-1377
Mailing Address - Fax:
Practice Address - Street 1:1841 W RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615-2504
Practice Address - Country:US
Practice Address - Phone:585-225-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061174122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist