Provider Demographics
NPI:1033085337
Name:RAFFI LEBLEBIJIAN
Entity type:Organization
Organization Name:RAFFI LEBLEBIJIAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT DESK MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-295-3785
Mailing Address - Street 1:876 N CONVENT ST
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1300
Mailing Address - Country:US
Mailing Address - Phone:815-933-4121
Mailing Address - Fax:
Practice Address - Street 1:876 N CONVENT ST
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1300
Practice Address - Country:US
Practice Address - Phone:815-933-4121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-14
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty