Provider Demographics
NPI:1841710316
Name:GARABEDIAN, RAFFIE (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:RAFFIE
Middle Name:
Last Name:GARABEDIAN
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 RUBERTA AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-2195
Mailing Address - Country:US
Mailing Address - Phone:818-588-0440
Mailing Address - Fax:
Practice Address - Street 1:1000 N CENTRAL AVE STE 130
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-3686
Practice Address - Country:US
Practice Address - Phone:818-588-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1014531223G0001X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223G0001XDental ProvidersDentistGeneral Practice