Provider Demographics
NPI:1083894612
Name:MARONIAN, RAFFI JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:RAFFI
Middle Name:JOHN
Last Name:MARONIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8358 TOPANGA CANYON BLVD
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-2344
Mailing Address - Country:US
Mailing Address - Phone:818-348-8400
Mailing Address - Fax:818-348-4040
Practice Address - Street 1:8358 TOPANGA CANYON BLVD
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91304-2344
Practice Address - Country:US
Practice Address - Phone:818-348-8400
Practice Address - Fax:818-348-4040
Is Sole Proprietor?:No
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45495122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist