Provider Demographics
NPI:1386767481
Name:RASEKHI, REZA (DDS)
Entity type:Individual
Prefix:
First Name:REZA
Middle Name:
Last Name:RASEKHI
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 1:665 N TUSTIN ST
Mailing Address - Street 2:SUITE W
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-7146
Mailing Address - Country:US
Mailing Address - Phone:714-289-8100
Mailing Address - Fax:
Practice Address - Street 1:665 N TUSTIN ST
Practice Address - Street 2:SUITE W
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-7146
Practice Address - Country:US
Practice Address - Phone:714-289-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA521061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice