Provider Demographics
NPI:1922126499
Name:RAFAAT, AMIRREZA (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMIRREZA
Middle Name:
Last Name:RAFAAT
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 1:504 ELDEN ST # 1
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4741
Mailing Address - Country:US
Mailing Address - Phone:703-724-0000
Mailing Address - Fax:703-724-1910
Practice Address - Street 1:504 ELDEN ST # 1
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4741
Practice Address - Country:US
Practice Address - Phone:703-724-0000
Practice Address - Fax:703-464-0066
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410532122300000X
VA0414105321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist