Provider Demographics
NPI:1578787933
Name:LOUIS, RUFINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUFINA
Middle Name:
Last Name:LOUIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:RUFINA
Other - Middle Name:
Other - Last Name:LOUIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:321 WYCKOFF AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-2720
Mailing Address - Country:US
Mailing Address - Phone:347-384-2278
Mailing Address - Fax:347-384-2278
Practice Address - Street 1:321 WYCKOFF AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-2753
Practice Address - Country:US
Practice Address - Phone:347-384-2278
Practice Address - Fax:347-384-2278
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0430621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01812615Medicaid