Samuel Donald Raffaelli, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

0401416875 Issued in VA

Practice address

620 Paul Jones Circle
Naval Medical Center: Oral Surgery Resident Room
Portsmouth, VA 23708-2370

Phone

(562) 322-0159

NPI assigned

Aug 5, 2019

Last updated

Feb 5, 2026By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1564963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770249600000",
    "number": "1841845062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7500 OCEAN FRONT AVE APT B",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234511954",
            "telephone_number": "562-322-0159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 PAUL JONES CIRCLE",
            "address_2": "NAVAL MEDICAL CENTER: ORAL SURGERY RESIDENT ROOM",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237082370",
            "telephone_number": "562-322-0159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAFFAELLI",
        "first_name": "SAMUEL",
        "middle_name": "DONALD",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-08-05",
        "last_updated": "2026-02-05",
        "certification_date": "2026-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "VA",
            "license": "043800492",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "VA",
            "license": "0401416875",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Portsmouth, VA
• Providers in Portsmouth, VA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.