Provider Demographics
NPI:1710675285
Name:AZER REFAAT, ANDRO EHAB (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDRO
Middle Name:EHAB
Last Name:AZER REFAAT
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 1:16475 SIERRA LAKES PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-1259
Mailing Address - Country:US
Mailing Address - Phone:909-525-0333
Mailing Address - Fax:
Practice Address - Street 1:16475 SIERRA LAKES PKWY STE 140
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-1259
Practice Address - Country:US
Practice Address - Phone:909-525-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1089151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice