Healthcare Provider Details

I. General information

NPI: 1851755292
Provider Name (Legal Business Name): BENJAMIN RAFAIL D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25823 HIGHWAY 290
CYPRESS TX
77429-1020
US

IV. Provider business mailing address

25823 HIGHWAY 290
CYPRESS TX
77429-1020
US

V. Phone/Fax

Practice location:
  • Phone: 281-373-5559
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number33450
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: