Provider Demographics
NPI:1528633286
Name:MAAN, RASOOL
Entity type:Individual
Prefix:
First Name:RASOOL
Middle Name:
Last Name:MAAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 E CRAIG RD UNIT 102
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-3321
Mailing Address - Country:US
Mailing Address - Phone:702-680-1009
Mailing Address - Fax:
Practice Address - Street 1:1820 E CRAIG RD UNIT 102
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-3321
Practice Address - Country:US
Practice Address - Phone:702-680-1009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7632TU122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty