Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | D009533 | AZ |
NPI | 1003269671 |
---|---|
Provider Name | Dr. Amanda Rafi |
First Address | Scottsdale, AZ 85259-5215 |
Second Address | Phoenix, AZ 85022-6337 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2016 |
Last Update Date | 19/07/2016 |