Healthcare Provider Details

I. General information

NPI: 1669382917
Provider Name (Legal Business Name): ARIANA RAFATY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 W WELLINGTON AVE
CHICAGO IL
60657-5650
US

IV. Provider business mailing address

336 W WELLINGTON AVE
CHICAGO IL
60657-5650
US

V. Phone/Fax

Practice location:
  • Phone: 224-639-5590
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019037448
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: