Provider Demographics
NPI:1710992128
Name:BARRY D. RAPHAEL, DMD, PA
Entity Type:Organization
Organization Name:BARRY D. RAPHAEL, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:RAPHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-778-4222
Mailing Address - Street 1:1425 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-4201
Mailing Address - Country:US
Mailing Address - Phone:973-778-4222
Mailing Address - Fax:973-778-9625
Practice Address - Street 1:1425 BROAD ST
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-4201
Practice Address - Country:US
Practice Address - Phone:973-778-4222
Practice Address - Fax:973-778-9625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 120401223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty