Provider Demographics
NPI:1447742184
Name:SAMPAIO, RAFAELLA (DMD)
Entity type:Individual
Prefix:
First Name:RAFAELLA
Middle Name:
Last Name:SAMPAIO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 SE 16TH PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-6845
Mailing Address - Country:US
Mailing Address - Phone:239-772-5005
Mailing Address - Fax:239-226-4650
Practice Address - Street 1:1527 SE 16TH PL
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-6845
Practice Address - Country:US
Practice Address - Phone:239-772-5005
Practice Address - Fax:239-226-4650
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN23346122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice