Provider Demographics
NPI:1902142722
Name:DIB, RAFIK (DDS , PHARM D)
Entity Type:Individual
Prefix:DR
First Name:RAFIK
Middle Name:
Last Name:DIB
Suffix:
Gender:M
Credentials:DDS , PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9091 AIRWAY DR APT 713
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-3345
Mailing Address - Country:US
Mailing Address - Phone:504-908-3711
Mailing Address - Fax:
Practice Address - Street 1:9091 AIRWAY DR APT 713
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-3345
Practice Address - Country:US
Practice Address - Phone:504-908-3711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-26
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA19121183500000X
LA64751223P0300X
FLDN226441223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No183500000XPharmacy Service ProvidersPharmacist