Healthcare Provider Details

I. General information

NPI: 1518519164
Provider Name (Legal Business Name): RAGY EMAD ADEL SAROUFIM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2019
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 S A ST
MADERA CA
93638-3619
US

IV. Provider business mailing address

124 S A ST
MADERA CA
93638-3619
US

V. Phone/Fax

Practice location:
  • Phone: 559-664-4000
  • Fax: 559-675-5224
Mailing address:
  • Phone: 559-664-4000
  • Fax: 559-675-5224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number35333
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number104977
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: