Provider Demographics
NPI:1659570372
Name:HAROUN, RAFFI (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAFFI
Middle Name:
Last Name:HAROUN
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 1:460 2ND AVE APT 12B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-9109
Mailing Address - Country:US
Mailing Address - Phone:818-400-2632
Mailing Address - Fax:
Practice Address - Street 1:248 W 23RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-2304
Practice Address - Country:US
Practice Address - Phone:212-242-3241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA523951223E0200X
NY524091223E0200X
CT0096631223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics