Provider Demographics
NPI:1245967660
Name:RIFAI, SARAH AMR (DDS)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:AMR
Last Name:RIFAI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1564 WIND ENERGY PASS
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-8929
Mailing Address - Country:US
Mailing Address - Phone:856-505-7302
Mailing Address - Fax:
Practice Address - Street 1:1564 WIND ENERGY PASS
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-8929
Practice Address - Country:US
Practice Address - Phone:856-505-7302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.033922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty