Provider Demographics
NPI:1780246207
Name:RIFAI, SARA
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:RIFAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3585 SW 38TH TER UNIT J202
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-5826
Mailing Address - Country:US
Mailing Address - Phone:407-928-6744
Mailing Address - Fax:
Practice Address - Street 1:4675 E SR 44 STE 104
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785-7461
Practice Address - Country:US
Practice Address - Phone:352-418-3041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-04
Last Update Date:2019-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24160122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist