Provider Demographics
NPI:1932527314
Name:REZAEE DENTAL
Entity Type:Organization
Organization Name:REZAEE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:REZAEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-683-8034
Mailing Address - Street 1:2400 WILLAMETTE ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3131
Mailing Address - Country:US
Mailing Address - Phone:541-683-8034
Mailing Address - Fax:541-485-3134
Practice Address - Street 1:2400 WILLAMETTE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3131
Practice Address - Country:US
Practice Address - Phone:541-683-8034
Practice Address - Fax:541-485-3134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7282122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty