Provider Demographics
NPI:1821761610
Name:RIFAT, DAVID ALI (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALI
Last Name:RIFAT
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 1:15903 CRAIGHURST DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77059-6422
Mailing Address - Country:US
Mailing Address - Phone:281-768-0506
Mailing Address - Fax:
Practice Address - Street 1:14815 WOODFOREST BLVD
Practice Address - Street 2:
Practice Address - City:CHANNELVIEW
Practice Address - State:TX
Practice Address - Zip Code:77530-3255
Practice Address - Country:US
Practice Address - Phone:281-457-6444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-27
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX374671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX37467OtherTEXAS STATE BOARD OF DENTAL EXAMINERS