Provider Demographics
NPI:1982704524
Name:BARSAM, RAFFI (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAFFI
Middle Name:
Last Name:BARSAM
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 1:4530 SHERMAN OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3010
Mailing Address - Country:US
Mailing Address - Phone:818-971-4600
Mailing Address - Fax:818-971-4603
Practice Address - Street 1:4530 SHERMAN OAKS AVE
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3010
Practice Address - Country:US
Practice Address - Phone:818-971-4600
Practice Address - Fax:818-971-4603
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA528281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice