Provider Demographics
NPI:1417413352
Name:RAFIUDDIN, SOBIA (DDS)
Entity Type:Individual
Prefix:
First Name:SOBIA
Middle Name:
Last Name:RAFIUDDIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 JERICHO TPKE STE 108
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-4501
Mailing Address - Country:US
Mailing Address - Phone:516-364-1444
Mailing Address - Fax:516-802-0039
Practice Address - Street 1:175 JERICHO TPKE STE 108
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4501
Practice Address - Country:US
Practice Address - Phone:516-364-1444
Practice Address - Fax:516-802-0039
Is Sole Proprietor?:No
Enumeration Date:2019-02-15
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0611451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice