Provider Demographics
NPI:1598755647
Name:RASSOULI, NADER M (BS DDS MS)
Entity Type:Individual
Prefix:DR
First Name:NADER
Middle Name:M
Last Name:RASSOULI
Suffix:
Gender:M
Credentials:BS DDS MS
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Mailing Address - Street 1:5440 SW WESTGATE DR
Mailing Address - Street 2:SUITE 360
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-2420
Mailing Address - Country:US
Mailing Address - Phone:503-297-4400
Mailing Address - Fax:503-297-0684
Practice Address - Street 1:5440 SW WESTGATE DR
Practice Address - Street 2:SUITE 360
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-2420
Practice Address - Country:US
Practice Address - Phone:503-297-4400
Practice Address - Fax:503-297-0684
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2016-02-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORD68321223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORD6832OtherDENTAL LICENSE