Provider Demographics
NPI:1407940372
Name:RAFIA, KASRA (DDS)
Entity Type:Individual
Prefix:
First Name:KASRA
Middle Name:
Last Name:RAFIA
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 1:930 NW 14TH AVE
Mailing Address - Street 2:220
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209
Mailing Address - Country:US
Mailing Address - Phone:503-889-8632
Mailing Address - Fax:503-223-1919
Practice Address - Street 1:930 NW 14TH AVE
Practice Address - Street 2:220
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209
Practice Address - Country:US
Practice Address - Phone:503-889-8632
Practice Address - Fax:503-223-1919
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7472122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist