Healthcare Provider Details

I. General information

NPI: 1376659607
Provider Name (Legal Business Name): AKRAM E RAFLA BDS, DMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SUITE 102 1 EAST MAIN ST
NORTHBORO MA
01532
US

IV. Provider business mailing address

SUITE 701 255 PARK AVE
WORCESTER MA
01609
US

V. Phone/Fax

Practice location:
  • Phone: 508-393-0161
  • Fax: 508-351-6900
Mailing address:
  • Phone: 508-363-4400
  • Fax: 508-363-4700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number18260
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: