Provider Demographics
NPI:1740928217
Name:RAGHIB, KYROLLOS
Entity type:Individual
Prefix:MR
First Name:KYROLLOS
Middle Name:
Last Name:RAGHIB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2386 WALNUT HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-4856
Mailing Address - Country:US
Mailing Address - Phone:407-760-2816
Mailing Address - Fax:
Practice Address - Street 1:2386 WALNUT HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-4856
Practice Address - Country:US
Practice Address - Phone:407-760-2816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN26934122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist