Provider Demographics
NPI:1366038499
Name:RAPHAEL LIY DDS LLC
Entity Type:Organization
Organization Name:RAPHAEL LIY DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LIY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:727-848-5525
Mailing Address - Street 1:1822 HEALTH CARE DR BLDG 6
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-5362
Mailing Address - Country:US
Mailing Address - Phone:727-848-5525
Mailing Address - Fax:
Practice Address - Street 1:1822 HEALTH CARE DR BLDG 6
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-5362
Practice Address - Country:US
Practice Address - Phone:727-848-5525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-13
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty