Provider Demographics
NPI:1619575057
Name:RAFIK DIB, DDS, LLC
Entity Type:Organization
Organization Name:RAFIK DIB, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFIK
Authorized Official - Middle Name:
Authorized Official - Last Name:DIB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD, PHARMD
Authorized Official - Phone:504-908-3711
Mailing Address - Street 1:7124 SPANISH TRL
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-6818
Mailing Address - Country:US
Mailing Address - Phone:504-908-3711
Mailing Address - Fax:
Practice Address - Street 1:3003 ENTERPRISE RD E
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-1304
Practice Address - Country:US
Practice Address - Phone:727-799-4492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty