Provider Demographics
NPI:1649601311
Name:EL RAFIE, KHALED MOATAZ (DMD)
Entity Type:Individual
Prefix:
First Name:KHALED
Middle Name:MOATAZ
Last Name:EL RAFIE
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 1:1203 BEACON ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5325
Mailing Address - Country:US
Mailing Address - Phone:617-232-8113
Mailing Address - Fax:617-232-1795
Practice Address - Street 1:1203 BEACON ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5325
Practice Address - Country:US
Practice Address - Phone:617-232-8113
Practice Address - Fax:617-232-1795
Is Sole Proprietor?:No
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18563971223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics