Healthcare Provider Details

I. General information

NPI: 1831384825
Provider Name (Legal Business Name): CLAIRE RAPHAEL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 05/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4432 CONLIN ST STE 1A
METAIRIE LA
70006-2146
US

IV. Provider business mailing address

4432 CONLIN ST STE 1A
METAIRIE LA
70006-2146
US

V. Phone/Fax

Practice location:
  • Phone: 504-888-9204
  • Fax:
Mailing address:
  • Phone: 504-888-9204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6367
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberZ11759
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: