Provider Demographics
NPI:1528761632
Name:RIFAI DENTAL GROUP PC
Entity type:Organization
Organization Name:RIFAI DENTAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HADIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIFAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-333-3368
Mailing Address - Street 1:948 S COURT ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-4848
Mailing Address - Country:US
Mailing Address - Phone:219-333-3368
Mailing Address - Fax:219-335-3368
Practice Address - Street 1:948 S COURT ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-4848
Practice Address - Country:US
Practice Address - Phone:219-333-3368
Practice Address - Fax:219-335-3368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental