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General NPI Number Information
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NPI Number | 1043556426
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Entity Type | Organization
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Legal Business Name | RANIA N. REFAAT, DDS, A PROF. DENTAL CORP
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Dates
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Enumeration Date | 12/12/2012
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Last Update Date | 09/24/2021
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Provider Practice Location Address
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Address Line | 304 N. MOUNTAIN AVE.
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City | UPLAND
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State | CA
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Zip | 91786
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Country | US
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Telephone | 909-989-1758
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Fax | 909-989-9874
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Provider Business Mailing Address
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Address Line | 304 N. MOUNTAIN AVE.
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City | UPLAND
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State | CA
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Zip | 91786
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Country | US
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Telephone | 909-989-1758
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Fax | 909-989-9874
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Authorized Official
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Title or Position | OWNER/DENTIST/PRESIDENT
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Name | RANIA N. REFAAT
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Credential | DDS
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Telephone | 909-989-1758
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 46326
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License Number State | CA
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