Provider Demographics
NPI:1841487295
Name:RASSEKHI, HAMID (DDS)
Entity type:Individual
Prefix:
First Name:HAMID
Middle Name:
Last Name:RASSEKHI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 -67 TH ST
Mailing Address - Street 2:3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219
Mailing Address - Country:US
Mailing Address - Phone:718-331-3611
Mailing Address - Fax:
Practice Address - Street 1:6200 BEACH CHANNEL DR
Practice Address - Street 2:
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1409
Practice Address - Country:US
Practice Address - Phone:718-945-7150
Practice Address - Fax:718-945-2596
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053107-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02827190Medicaid