Provider Demographics
NPI:1437571783
Name:RAFI DAVIDIAN DMD CORP
Entity Type:Organization
Organization Name:RAFI DAVIDIAN DMD CORP
Other - Org Name:DOWNTOWN SMILE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:805-486-3911
Mailing Address - Street 1:826 S A ST
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-7140
Mailing Address - Country:US
Mailing Address - Phone:805-486-3911
Mailing Address - Fax:805-486-3921
Practice Address - Street 1:826 S A ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-7140
Practice Address - Country:US
Practice Address - Phone:805-486-3911
Practice Address - Fax:805-486-3921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-06
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA559041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty