Healthcare Provider Details

I. General information

NPI: 1144587064
Provider Name (Legal Business Name): RAFFI ASADORIAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 PARTRIDGE DR STE 210
VENTURA CA
93003-0716
US

IV. Provider business mailing address

1001 PARTRIDGE DR STE 210
VENTURA CA
93003-0716
US

V. Phone/Fax

Practice location:
  • Phone: 805-644-9501
  • Fax:
Mailing address:
  • Phone: 805-644-9501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number103063
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: