Provider Demographics
NPI:1891810263
Name:RAFIEI, GITA (DDS)
Entity Type:Individual
Prefix:DR
First Name:GITA
Middle Name:
Last Name:RAFIEI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:GITA
Other - Middle Name:
Other - Last Name:RAFIEI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3900 W 15TH ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-7751
Mailing Address - Country:US
Mailing Address - Phone:972-596-6920
Mailing Address - Fax:972-867-7130
Practice Address - Street 1:3900 W 15TH ST
Practice Address - Street 2:SUITE 401
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7751
Practice Address - Country:US
Practice Address - Phone:972-596-6920
Practice Address - Fax:972-867-7130
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX199611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice