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General NPI Number Information
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NPI Number | 1841845062
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Entity Type | Individual
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Provider Name | SAMUEL DONALD RAFFAELLI DDS
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Gender | Male
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Dates
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Enumeration Date | 08/05/2019
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Last Update Date | 02/05/2026
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Provider Practice Location Address
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Address Line | 620 PAUL JONES CIRCLE NAVAL MEDICAL CENTER: ORAL SURGERY RESIDENT ROOM
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City | PORTSMOUTH
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State | VA
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Zip | 23708-2370
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Country | US
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Telephone | 562-322-0159
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Fax |
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Provider Business Mailing Address
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Address Line | 7500 OCEAN FRONT AVE APT B
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-1954
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Country | US
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Telephone | 562-322-0159
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 043800492
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 0401416875
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License Number State | VA
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