Provider Demographics
NPI:1952036089
Name:FEROZ, MOHAMMED RAFI (DMD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:RAFI
Last Name:FEROZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:RAFI
Other - Middle Name:
Other - Last Name:FEROZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:10380 HITE CIR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-3523
Mailing Address - Country:US
Mailing Address - Phone:916-476-0117
Mailing Address - Fax:
Practice Address - Street 1:8400 WOOD THRUSH WAY
Practice Address - Street 2:
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-6120
Practice Address - Country:US
Practice Address - Phone:916-476-0117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1076371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice