Provider Demographics
NPI:1841845062
Name:RAFFAELLI, SAMUEL DONALD (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:DONALD
Last Name:RAFFAELLI
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 1:7500 OCEAN FRONT AVE APT B
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-1954
Mailing Address - Country:US
Mailing Address - Phone:562-322-0159
Mailing Address - Fax:
Practice Address - Street 1:620 PAUL JONES CIRCLE
Practice Address - Street 2:NAVAL MEDICAL CENTER: ORAL SURGERY RESIDENT ROOM
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2370
Practice Address - Country:US
Practice Address - Phone:562-322-0159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014168751223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery