Provider Demographics
NPI:1831384825
Name:RAPHAEL, CLAIRE (DDS)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:
Last Name:RAPHAEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4432 CONLIN ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2146
Mailing Address - Country:US
Mailing Address - Phone:504-888-9204
Mailing Address - Fax:
Practice Address - Street 1:4432 CONLIN ST STE 1A
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2146
Practice Address - Country:US
Practice Address - Phone:504-888-9204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2013-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ11759225X00000X
LA63671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist