Provider Demographics
NPI:1083040414
Name:RAFFI LEBLEBIJIAN DR RAFFI LEBLEBIJIAN & ASSOC
Entity Type:Organization
Organization Name:RAFFI LEBLEBIJIAN DR RAFFI LEBLEBIJIAN & ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAFFI
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBLEBIJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-933-4121
Mailing Address - Street 1:401 N WALL ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-2934
Mailing Address - Country:US
Mailing Address - Phone:815-933-4121
Mailing Address - Fax:815-933-6744
Practice Address - Street 1:401 N WALL ST
Practice Address - Street 2:SUITE 203
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2934
Practice Address - Country:US
Practice Address - Phone:815-933-4121
Practice Address - Fax:815-933-6744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019020125122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty