Provider Demographics
NPI:1619158474
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:NEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH-HOSSEINI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, CAGS
Authorized Official - Phone:617-734-9360
Mailing Address - Street 1:1678 BEACON STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-2113
Mailing Address - Country:US
Mailing Address - Phone:617-734-9360
Mailing Address - Fax:617-731-0917
Practice Address - Street 1:1678 BEACON STREET
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-2113
Practice Address - Country:US
Practice Address - Phone:617-734-9360
Practice Address - Fax:617-731-0917
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RASOOL & SHAH HOSSEINI INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-21
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA188021223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty