Provider Demographics
NPI:1780490292
Name:ALEJANDRA B RAFTACCO DDS A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:ALEJANDRA B RAFTACCO DDS A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRA
Authorized Official - Middle Name:BEATRIZ
Authorized Official - Last Name:RAFTACCO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-422-7181
Mailing Address - Street 1:14074 OSBORNE ST
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-2602
Mailing Address - Country:US
Mailing Address - Phone:818-810-0050
Mailing Address - Fax:
Practice Address - Street 1:14074 OSBORNE ST
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-2602
Practice Address - Country:US
Practice Address - Phone:818-810-0050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental