Provider Demographics
NPI:1447455225
Name:RASSOULIAN, SHAHBOD (D)
Entity type:Individual
Prefix:
First Name:SHAHBOD
Middle Name:
Last Name:RASSOULIAN
Suffix:
Gender:M
Credentials:D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 BRICKELL KEY BLVD
Mailing Address - Street 2:SUITE 3311
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-3711
Mailing Address - Country:US
Mailing Address - Phone:305-373-4664
Mailing Address - Fax:954-432-8908
Practice Address - Street 1:11401 PINES BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026
Practice Address - Country:US
Practice Address - Phone:954-432-5515
Practice Address - Fax:954-432-8908
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN144821223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics