Provider Demographics
NPI:1285168906
Name:AMIRREZA RAFAAT DDS PC
Entity type:Organization
Organization Name:AMIRREZA RAFAAT DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMIRREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAFAAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-724-4220
Mailing Address - Street 1:19450 DEERFIELD AVE STE 465
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-6822
Mailing Address - Country:US
Mailing Address - Phone:703-724-4220
Mailing Address - Fax:703-724-1910
Practice Address - Street 1:19450 DEERFIELD AVE STE 465
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-6822
Practice Address - Country:US
Practice Address - Phone:703-724-4220
Practice Address - Fax:703-724-1910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410532332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies