Active NPI
Dennis Mark Rafferty, D.D.S.
- Periodontics
- Birmingham, AL
National Provider Identifier
1609895028
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 4661
- Practice address
- 700 19TH St S
Dept 160
Birmingham, AL 35233-1927 - Phone
- (205) 933-8101
- Fax
- (205) 558-4779
- NPI assigned
- Jul 18, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 4661 | AL | Primary |
Addresses
Primary practice location
700 19TH St S
Dept 160
Birmingham, AL 35233-1927
Mailing address
1420 Canyon LN
Birmingham, AL 35244-6575
Phone (205) 933-8101
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4661 | AL | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1609895028",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1420 CANYON LN",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352446575",
"telephone_number": "205-933-8101",
"fax_number": "205-558-4779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 19TH ST S",
"address_2": "DEPT 160",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352331927",
"telephone_number": "205-933-8101",
"fax_number": "205-558-4779"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAFFERTY",
"first_name": "DENNIS",
"middle_name": "MARK",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "AL",
"license": "4661",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Birmingham, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.