Provider Demographics
NPI:1609590462
Name:SUAREZ, RAFAEL ANGEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:ANGEL
Last Name:SUAREZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8417 AMBROSSE LN UNIT 104
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-7367
Mailing Address - Country:US
Mailing Address - Phone:502-210-3918
Mailing Address - Fax:
Practice Address - Street 1:9219 US HIGHWAY 42 STE A
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-8875
Practice Address - Country:US
Practice Address - Phone:502-228-2709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY108461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice