Provider Demographics
NPI:1710143177
Name:RIFAI, MAHER JANDALI (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:MAHER
Middle Name:JANDALI
Last Name:RIFAI
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WEST MARTIN AVE
Mailing Address - Street 2:SUITE 164
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-1334
Mailing Address - Country:US
Mailing Address - Phone:630-961-5151
Mailing Address - Fax:
Practice Address - Street 1:10 WEST MARTIN AVE
Practice Address - Street 2:SUITE 164
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-1334
Practice Address - Country:US
Practice Address - Phone:630-961-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18571641223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400301731OtherMEDICARE PTAN