MEDICARE: DR. RAFAEL KHAVIS DENTIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	026688	OH

General Provider Information

NPI Number	:	1578175089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAFAEL KHAVIS DENTIST

Provider Business Mailing Address
First Line	:	5596 MAYFIELD RD
Second Line	:
City	:	LYNDHURST
State	:	OH
Zip	:	44124-2921
Country	:	US
Telephone Number	:	440-442-8220
Fax Number	:	440-442-1090

Provider Business Practice Location Address
First Line	:	5596 MAYFIELD RD
Second Line	:
City	:	LYNDHURST
State	:	OH
Zip	:	44124-2921
Country	:	US
Telephone Number	:	440-442-8220
Fax Number	:	440-442-1090

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2020
Last Update Date	:	03/08/2026

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