MEDICARE: RAFAEL LEVONOVICH GARIBYAN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1598608283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAFAEL LEVONOVICH GARIBYAN DMD

Provider Business Mailing Address
First Line	:	31041 EVERGREEN CT
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48331-1179
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16800 W 12 MILE RD STE 103
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-6335
Country	:	US
Telephone Number	:	248-352-4789
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2026
Last Update Date	:	04/09/2026

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