Provider Demographics
NPI:1376594754
Name:LEBLEBIJIAN, RAFFI K (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAFFI
Middle Name:K
Last Name:LEBLEBIJIAN
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 1:401 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A201251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice