Healthcare Provider Details

I. General information

NPI: 1598608283
Provider Name (Legal Business Name): RAFAEL LEVONOVICH GARIBYAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

G3538 MILLER RD STE A
FLINT MI
48507-1271
US

IV. Provider business mailing address

31041 EVERGREEN CT
FARMINGTON HILLS MI
48331-1179
US

V. Phone/Fax

Practice location:
  • Phone: 810-424-0400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901603002
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: