Provider Demographics
NPI:1801914502
Name:RAFEEDIE, STEVEN P (DMD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:P
Last Name:RAFEEDIE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7454 HANNOVER PKWY S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7889
Mailing Address - Country:US
Mailing Address - Phone:770-507-7520
Mailing Address - Fax:770-507-7526
Practice Address - Street 1:7454 HANNOVER PKWY S
Practice Address - Street 2:SUITE 200
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7889
Practice Address - Country:US
Practice Address - Phone:770-507-7520
Practice Address - Fax:770-507-7526
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0111111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice