Provider Demographics
NPI:1356408868
Name:NADAL, RAFAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:
Last Name:NADAL
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 1:1713 W FAIRBANKS AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4605
Mailing Address - Country:US
Mailing Address - Phone:407-629-1804
Mailing Address - Fax:407-629-1889
Practice Address - Street 1:1713 W FAIRBANKS AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4605
Practice Address - Country:US
Practice Address - Phone:407-629-1804
Practice Address - Fax:407-629-1889
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 178221223G0001X
PR23881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR041972OtherCRUZ AZUL
PR2332OtherIMC
PR42339OtherTRIPLE S
PR70526OtherPREFERRED MEDICARE CHOICE
PR6800105OtherHUMANA