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General NPI Number Information
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NPI Number | 1750459194
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Entity Type | Individual
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Provider Name | RAFAEL ISAKHAROV DDS
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Gender | Male
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Dates
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Enumeration Date | 12/02/2006
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Last Update Date | 04/14/2021
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Provider Practice Location Address
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Address Line | 9819 64TH AVE SUITE 1H
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City | REGO PARK
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State | NY
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Zip | 11374-2542
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Country | US
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Telephone | 718-897-9745
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Fax |
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Provider Business Mailing Address
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Address Line | 10231 68TH AVE
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City | FOREST HILLS
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State | NY
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Zip | 11375-3142
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 049803-1
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License Number State | NY
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