Provider Demographics
NPI:1093987018
Name:RAFAILOV, SALAMON
Entity Type:Individual
Prefix:DR
First Name:SALAMON
Middle Name:
Last Name:RAFAILOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 VILLAGE SQ E
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-1555
Mailing Address - Country:US
Mailing Address - Phone:973-546-7227
Mailing Address - Fax:
Practice Address - Street 1:6 VILLAGE SQ E
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-1555
Practice Address - Country:US
Practice Address - Phone:973-546-7227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02366600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist