Provider Demographics
NPI:1750459194
Name:ISAKHAROV, RAFAEL (DDS)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:ISAKHAROV
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 1:10231 68TH AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3142
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9819 64TH AVE
Practice Address - Street 2:SUITE 1H
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2542
Practice Address - Country:US
Practice Address - Phone:718-897-9745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049803-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist