Provider Demographics
NPI:1740768167
Name:RAPHAEL, WASSAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:WASSAN
Middle Name:
Last Name:RAPHAEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:WASSAN
Other - Middle Name:
Other - Last Name:ARABO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:4445 PERKINS ST APT 105
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-3460
Mailing Address - Country:US
Mailing Address - Phone:248-378-8961
Mailing Address - Fax:
Practice Address - Street 1:4445 PERKINS ST APT 105
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-3460
Practice Address - Country:US
Practice Address - Phone:248-378-8961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0418671223G0001X
LA7050122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice