Provider Demographics
NPI:1750842456
Name:RAFIKOVA, DILAFRUZ
Entity Type:Individual
Prefix:
First Name:DILAFRUZ
Middle Name:
Last Name:RAFIKOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 OCEAN PKWY APT D19
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7016
Mailing Address - Country:US
Mailing Address - Phone:646-331-7231
Mailing Address - Fax:
Practice Address - Street 1:3002 MERMAID AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-1806
Practice Address - Country:US
Practice Address - Phone:718-975-4475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061375122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist