Provider Demographics
NPI:1891338224
Name:HUSSAIN, SYED RASSAL (DMD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:RASSAL
Last Name:HUSSAIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 N HOWARD ST APT 310
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-3476
Mailing Address - Country:US
Mailing Address - Phone:518-892-7103
Mailing Address - Fax:
Practice Address - Street 1:2401 BELAIR RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-1200
Practice Address - Country:US
Practice Address - Phone:410-522-5777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD171651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice