MEDICARE: RAFFIC A. MACKIE D.D.S., P.C.& ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	11656	MI

General Provider Information

NPI Number	:	1104027127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAFFIC A. MACKIE D.D.S., P.C.& ASSOCIATES

Provider Business Mailing Address
First Line	:	7911 WYOMING ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-1223
Country	:	US
Telephone Number	:	313-834-9551
Fax Number	:	313-834-9595

Provider Business Practice Location Address
First Line	:	7911 WYOMING ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-1223
Country	:	US
Telephone Number	:	313-834-9551
Fax Number	:	313-834-9595

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MISS KIMBERLY GOUTIMY
Credential	:
Telephone Number	:	313-834-9551

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	08/22/2020

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