Provider Demographics
NPI:1174291629
Name:NASROLAHI, NEEKA (DMD)
Entity Type:Individual
Prefix:DR
First Name:NEEKA
Middle Name:
Last Name:NASROLAHI
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 1:535 NW 11TH AVE APT 701
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-4066
Mailing Address - Country:US
Mailing Address - Phone:951-317-0675
Mailing Address - Fax:
Practice Address - Street 1:19129 BEAVERCREEK RD
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-9539
Practice Address - Country:US
Practice Address - Phone:951-317-0675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD114801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice