Provider Demographics
NPI:1932783560
Name:RAFAEL ISAKHAROV DDS PC
Entity Type:Organization
Organization Name:RAFAEL ISAKHAROV DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ISAKHAROV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-341-9863
Mailing Address - Street 1:9819 64TH AVE APT 1H
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2525
Mailing Address - Country:US
Mailing Address - Phone:718-897-9745
Mailing Address - Fax:
Practice Address - Street 1:9819 64TH AVE APT 1H
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2525
Practice Address - Country:US
Practice Address - Phone:718-897-9745
Practice Address - Fax:646-889-2823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty