Provider Demographics
NPI:1730920661
Name:GARCEZ, RAFAEL GONZALEZ (DMD)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:GONZALEZ
Last Name:GARCEZ
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 1:4708 WINNIPESAUKEE LN
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-3557
Mailing Address - Country:US
Mailing Address - Phone:919-607-5853
Mailing Address - Fax:
Practice Address - Street 1:3500 N DUKE ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-1707
Practice Address - Country:US
Practice Address - Phone:919-607-5853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13693122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist