Provider Demographics
NPI:1689795205
Name:YANEZ, RAFAEL ENRIQUE (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:ENRIQUE
Last Name:YANEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:NA
Other - Middle Name:NA
Other - Last Name:NA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:200 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3904
Mailing Address - Country:US
Mailing Address - Phone:215-923-2233
Mailing Address - Fax:
Practice Address - Street 1:200 WALNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3904
Practice Address - Country:US
Practice Address - Phone:215-923-2233
Practice Address - Fax:888-608-7353
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037084122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist