Provider Demographics
NPI:1679309454
Name:RAPHAIL, ISRAEL (DMD)
Entity type:Individual
Prefix:
First Name:ISRAEL
Middle Name:
Last Name:RAPHAIL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:RAPHAIL
Other - Middle Name:
Other - Last Name:ISRAEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:150 MARKETPLACE BLVD UNIT 3
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-4387
Mailing Address - Country:US
Mailing Address - Phone:603-392-7654
Mailing Address - Fax:
Practice Address - Street 1:150 MARKETPLACE BLVD UNIT 3
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-4387
Practice Address - Country:US
Practice Address - Phone:603-392-7654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH051381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice