Provider Demographics
NPI:1033625074
Name:ROFAEIL, MENA RAAFAT ZAKI (DDS)
Entity Type:Individual
Prefix:DR
First Name:MENA
Middle Name:RAAFAT ZAKI
Last Name:ROFAEIL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3641 CLAYTON RD APT 15
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-2579
Mailing Address - Country:US
Mailing Address - Phone:424-303-0707
Mailing Address - Fax:
Practice Address - Street 1:351 FELICE DR
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-3361
Practice Address - Country:US
Practice Address - Phone:831-637-5306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-28
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1022211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice