Provider Demographics
NPI:1548889371
Name:RAFETTO, BRIANNA TAYLOR (DMD)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:TAYLOR
Last Name:RAFETTO
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 1:600 N BROAD ST STE 7
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-1032
Mailing Address - Country:US
Mailing Address - Phone:302-376-7882
Mailing Address - Fax:
Practice Address - Street 1:600 N BROAD ST STE 7
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-1032
Practice Address - Country:US
Practice Address - Phone:302-376-7882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-12
Last Update Date:2021-08-05
Deactivation Date:2021-07-07
Deactivation Code:
Reactivation Date:2021-07-20
Provider Licenses
StateLicense IDTaxonomies
390200000X
DEG1-00114881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program