Provider Demographics
NPI:1578867065
Name:HIRJI, RAFIQ (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAFIQ
Middle Name:
Last Name:HIRJI
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 1:1005 SUMAC DR
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76262-8834
Mailing Address - Country:US
Mailing Address - Phone:805-680-8490
Mailing Address - Fax:
Practice Address - Street 1:1005 SUMAC DR
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76262-8834
Practice Address - Country:US
Practice Address - Phone:805-680-8490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-27
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX217426005Medicaid