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General NPI Number Information
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NPI Number | 1992985808
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Entity Type | Organization
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Legal Business Name | RAFFI R BARSAM DMD COSMETIC AND GENERAL DENTISTRY
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 11/07/2007
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Provider Practice Location Address
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Address Line | 4530 SHERMAN OAKS AVE
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-3010
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Country | US
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Telephone | 818-971-4600
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Fax | 818-971-4603
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Provider Business Mailing Address
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Address Line | 4530 SHERMAN OAKS AVE
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-3010
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Country | US
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Telephone | 818-971-4600
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Fax | 818-971-4603
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Authorized Official
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Title or Position | OWNER DOCTOR
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Name | DR. RAFFI R BARSAM
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Credential | DMD
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Telephone | 818-971-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 52828
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License Number State | CA
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