Provider Demographics
NPI:1407540776
Name:MARTINS AFONSO PEREIRA, RAFAEL (DDS, MS)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:MARTINS AFONSO PEREIRA
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:RAFAEL
Other - Middle Name:
Other - Last Name:PEREIRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:11512 LAKE MEAD AVE UNIT 532
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9733
Mailing Address - Country:US
Mailing Address - Phone:904-683-4781
Mailing Address - Fax:
Practice Address - Street 1:11512 LAKE MEAD AVE UNIT 532
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9733
Practice Address - Country:US
Practice Address - Phone:904-683-4781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901602700122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist