Provider Demographics
NPI:1093357543
Name:RAFFERTY, MEGAN (RDA/CDA)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:RAFFERTY
Suffix:
Gender:F
Credentials:RDA/CDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 9TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-1528
Mailing Address - Country:US
Mailing Address - Phone:210-951-3280
Mailing Address - Fax:210-858-9220
Practice Address - Street 1:427 9TH ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1528
Practice Address - Country:US
Practice Address - Phone:210-951-3280
Practice Address - Fax:210-858-9220
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant