Healthcare Provider Details

I. General information

NPI: 1306121603
Provider Name (Legal Business Name): RAFAELA ST. HILL RDH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RAFAELA RODRIGUEZ DENTAL HYGIENIST

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 BRIGGS HIGHWAY
ELLENVILLE NY
12428
US

IV. Provider business mailing address

270 LEGGETT RD
HIGH FALLS NY
12440
US

V. Phone/Fax

Practice location:
  • Phone: 845-647-2000
  • Fax: 845-647-2302
Mailing address:
  • Phone: 845-647-2000
  • Fax: 845-647-2302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number022974-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: