Provider Demographics
NPI:1184013773
Name:YEKTA RAFATY DDS, INC.
Entity Type:Organization
Organization Name:YEKTA RAFATY DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRES., CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:YEKTA
Authorized Official - Middle Name:B
Authorized Official - Last Name:RAFATY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-325-0465
Mailing Address - Street 1:888 OAK GROVE AVE.
Mailing Address - Street 2:SUITE #2
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025
Mailing Address - Country:US
Mailing Address - Phone:650-325-0465
Mailing Address - Fax:650-325-1431
Practice Address - Street 1:888 OAK GROVE AVE.
Practice Address - Street 2:SUITE #2
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025
Practice Address - Country:US
Practice Address - Phone:650-325-0465
Practice Address - Fax:650-325-1431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA397301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty