Provider Demographics
NPI:1194019091
Name:RIFAI, HADIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:HADIE
Middle Name:
Last Name:RIFAI
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 1:948 S COURT ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-4848
Mailing Address - Country:US
Mailing Address - Phone:219-333-3368
Mailing Address - Fax:
Practice Address - Street 1:948 S COURT ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-4848
Practice Address - Country:US
Practice Address - Phone:219-333-3368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011635A122300000X
OH30.023512122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist