Provider Demographics
NPI:1467559583
Name:MARGOSSIAN, RAFFI H (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:RAFFI
Middle Name:H
Last Name:MARGOSSIAN
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 W ALAMEDA AVE STE 308
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4408
Mailing Address - Country:US
Mailing Address - Phone:818-821-7999
Mailing Address - Fax:818-842-8411
Practice Address - Street 1:2701 W ALAMEDA AVE STE 308
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4408
Practice Address - Country:US
Practice Address - Phone:818-821-7999
Practice Address - Fax:818-842-8411
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36718122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD36718AMedicare UPIN