Provider Demographics
NPI:1730337379
Name:ROFAEL DENTAL CORP.
Entity type:Organization
Organization Name:ROFAEL DENTAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:MEDHAT
Authorized Official - Middle Name:M RAOUF
Authorized Official - Last Name:ROFAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-444-4224
Mailing Address - Street 1:17150 EUCLID ST STE 311
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4092
Mailing Address - Country:US
Mailing Address - Phone:714-444-4224
Mailing Address - Fax:
Practice Address - Street 1:17150 EUCLID ST STE 311
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4092
Practice Address - Country:US
Practice Address - Phone:714-444-4224
Practice Address - Fax:714-444-9480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4071401OtherMEDICARE