Provider Demographics
NPI:1952773590
Name:AZER REFAAT, MICHEL (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:MICHEL
Middle Name:
Last Name:AZER REFAAT
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 BERING DR STE 110
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-3186
Mailing Address - Country:US
Mailing Address - Phone:909-614-3693
Mailing Address - Fax:
Practice Address - Street 1:1811 BERING DR STE 110
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-3186
Practice Address - Country:US
Practice Address - Phone:909-614-3693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL126221223P0300X
TX338431223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MABB1832268PMRIOtherDEA
TXFA9113591OtherDEA