Provider Demographics
NPI:1255528402
Name:YAGHI, RAWAN (DDS)
Entity type:Individual
Prefix:DR
First Name:RAWAN
Middle Name:
Last Name:YAGHI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:BIG LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55309-9572
Mailing Address - Country:US
Mailing Address - Phone:763-263-2222
Mailing Address - Fax:763-263-5822
Practice Address - Street 1:195 JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:BIG LAKE
Practice Address - State:MN
Practice Address - Zip Code:55309-9572
Practice Address - Country:US
Practice Address - Phone:763-263-2222
Practice Address - Fax:763-263-5822
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND120781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MND12078OtherLICENSE NUMBER