Provider Demographics
NPI:1346800109
Name:RAFFI G. CHALIAN D.D.S., INC.
Entity Type:Organization
Organization Name:RAFFI G. CHALIAN D.D.S., INC.
Other - Org Name:CAMARILLO DENTAL STUDIO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFFI
Authorized Official - Middle Name:G
Authorized Official - Last Name:CHALIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-445-1333
Mailing Address - Street 1:2107 PICKWICK DR
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-6427
Mailing Address - Country:US
Mailing Address - Phone:805-445-1333
Mailing Address - Fax:
Practice Address - Street 1:2107 PICKWICK DR
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-6427
Practice Address - Country:US
Practice Address - Phone:805-445-1333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-14
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA38972OtherDENTAL LICENSE NUMBER