Provider Demographics
NPI:1386712297
Name:RAFFO, MICHAEL JOSEPH (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:RAFFO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 SUNSET TER
Mailing Address - Street 2:
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-3818
Mailing Address - Country:US
Mailing Address - Phone:831-600-3261
Mailing Address - Fax:831-466-9483
Practice Address - Street 1:2001 40TH AVE STE G
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2536
Practice Address - Country:US
Practice Address - Phone:831-476-8700
Practice Address - Fax:831-465-7600
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54933122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist