Provider Demographics
NPI:1871583468
Name:RAFAL, GARY STEVEN (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:STEVEN
Last Name:RAFAL
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 1:99 15 SEAVIEW AVE.
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236
Mailing Address - Country:US
Mailing Address - Phone:718-763-7799
Mailing Address - Fax:718-763-7846
Practice Address - Street 1:99 15 SEAVIEW AVE.
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236
Practice Address - Country:US
Practice Address - Phone:718-763-7799
Practice Address - Fax:718-763-7846
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037737-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist