Provider Demographics
NPI:1700991387
Name:RAPHAEL, DONALD (DDS)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:RAPHAEL
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 1:1200 E WOODHUNT DR
Mailing Address - Street 2:#A400
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-3746
Mailing Address - Country:US
Mailing Address - Phone:417-882-0500
Mailing Address - Fax:417-882-6025
Practice Address - Street 1:1200 E WOODHUNT DR
Practice Address - Street 2:#A400
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-3746
Practice Address - Country:US
Practice Address - Phone:417-882-0500
Practice Address - Fax:417-882-6025
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO13259122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist