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General NPI Number Information
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NPI Number | 1932783560
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Entity Type | Organization
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Legal Business Name | RAFAEL ISAKHAROV DDS PC
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Dates
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Enumeration Date | 05/10/2021
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Last Update Date | 05/10/2021
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Provider Practice Location Address
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Address Line | 9819 64TH AVE APT 1H
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City | REGO PARK
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State | NY
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Zip | 11374-2525
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Country | US
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Telephone | 718-897-9745
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Fax | 646-889-2823
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Provider Business Mailing Address
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Address Line | 9819 64TH AVE APT 1H
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City | REGO PARK
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State | NY
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Zip | 11374-2525
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Country | US
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Telephone | 718-897-9745
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RAFAEL ISAKHAROV
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Credential |
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Telephone | 347-341-9863
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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 |
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License Number State |
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