Jordan Rafferty, D.M.D
Individual provider Active NPI Dentist · Victoria, VA
NPI 1972395713 · NPPES record last updated Aug 3, 2026
Key facts
- NPI
- 1972395713
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 0401419886 (VA)
- Practice address
- 1418 6TH St
Victoria, VA 23974 - Phone
- (434) 696-4180
- NPI assigned
- May 19, 2025
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 0401419886 | VA | Yes |
Addresses
Primary practice location
1418 6TH St
Victoria, VA 23974
Mailing address
1418 6TH St
Victoria, VA 23974
Phone (434) 696-4180
Other providers in Victoria, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 3, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.