Provider Demographics
NPI:1558664383
Name:REZA RASEKHI, D.D.S.
Entity Type:Organization
Organization Name:REZA RASEKHI, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:RASEKHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-289-8100
Mailing Address - Street 1:665 N TUSTIN ST
Mailing Address - Street 2:SUITE W
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-7146
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:665 N TUSTIN ST
Practice Address - Street 2:SUITE W
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-7146
Practice Address - Country:US
Practice Address - Phone:714-289-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52106261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental