Provider Demographics
NPI:1235145442
Name:RASOOL & SHAH HOSSEINI INC
Entity Type:Organization
Organization Name:RASOOL & SHAH HOSSEINI INC
Other - Org Name:BROOKLINE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:S
Authorized Official - Middle Name:FAHEEM
Authorized Official - Last Name:RASOOL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD,MMSC
Authorized Official - Phone:617-734-8599
Mailing Address - Street 1:1199 BEACON ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5352
Mailing Address - Country:US
Mailing Address - Phone:617-734-8599
Mailing Address - Fax:617-739-8452
Practice Address - Street 1:1199 BEACON ST
Practice Address - Street 2:UNIT 1
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5352
Practice Address - Country:US
Practice Address - Phone:617-734-8599
Practice Address - Fax:617-739-8452
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RASOOL & SHAH HOSSEINI INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-31
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223P0300X, 1223P0700X
MA188011223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty