Healthcare Provider Details

I. General information

NPI: 1003269671
Provider Name (Legal Business Name): AMANDA RAFI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2016
Last Update Date: 07/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 E BELL RD STE 3
PHOENIX AZ
85022-6337
US

IV. Provider business mailing address

10201 N 124TH ST
SCOTTSDALE AZ
85259-5215
US

V. Phone/Fax

Practice location:
  • Phone: 602-993-6000
  • Fax:
Mailing address:
  • Phone: 480-510-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD009533
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: