MEDICARE: DAVID MARK RAIFFE DDS

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	019625	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174829287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID MARK RAIFFE DDS

Provider Business Mailing Address
First Line	:	1019 N PARK AVE
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44483-3725
Country	:	US
Telephone Number	:	330-395-3820
Fax Number	:

Provider Business Practice Location Address
First Line	:	916 KENMORE BLVD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44314-2113
Country	:	US
Telephone Number	:	330-753-8155
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2011
Last Update Date	:	12/22/2017

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Directions to “ DAVID MARK RAIFFE DDS” Practice Location

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