Healthcare Provider Details

I. General information

NPI: 1710548342
Provider Name (Legal Business Name): ANDREW MICHAEL RAFIE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1583 E COMMON ST STE 205
NEW BRAUNFELS TX
78130-3174
US

IV. Provider business mailing address

104 W CEDAR ST
SEGUIN TX
78155-3748
US

V. Phone/Fax

Practice location:
  • Phone: 830-625-2111
  • Fax:
Mailing address:
  • Phone: 210-483-3169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number35389
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: