Provider Demographics
NPI:1720288400
Name:DAVIDIAN, RAFI (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAFI
Middle Name:
Last Name:DAVIDIAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA559041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice