Provider Demographics
NPI:1174721641
Name:KHAMIS, RAFID ISMAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:RAFID
Middle Name:ISMAEL
Last Name:KHAMIS
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 1:329 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93927
Mailing Address - Country:US
Mailing Address - Phone:831-674-0235
Mailing Address - Fax:831-674-0236
Practice Address - Street 1:329 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:CA
Practice Address - Zip Code:93927
Practice Address - Country:US
Practice Address - Phone:831-674-0235
Practice Address - Fax:831-674-0236
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA504771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice