Provider Demographics
NPI:1720202062
Name:CHAUDREY, MUHAMMAD RAFI (DDS)
Entity Type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:RAFI
Last Name:CHAUDREY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 ELM ST
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-1513
Mailing Address - Country:US
Mailing Address - Phone:518-483-2652
Mailing Address - Fax:
Practice Address - Street 1:586 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-2034
Practice Address - Country:US
Practice Address - Phone:518-483-7733
Practice Address - Fax:518-483-7733
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0324581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice