1205950995 NPI number — DR. MICHELE CARTER RAVENEL DMD

Table of content: DR. MICHELE CARTER RAVENEL DMD (NPI 1205950995)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205950995 NPI number — DR. MICHELE CARTER RAVENEL DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAVENEL
Provider First Name:
MICHELE
Provider Middle Name:
CARTER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARTER
Provider Other First Name:
MICHELE
Provider Other Middle Name:
AILEEN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205950995
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1466 HEADQUARTERS PLANTATION DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOHNS ISLAND
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29455-3103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-557-0696
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
173 ASHLEY AVE
Provider Second Line Business Practice Location Address:
BSB 124 COLLEGE OF DENTAL MEDICINE
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29425-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-792-7258
Provider Business Practice Location Address Fax Number:
843-792-2150
Provider Enumeration Date:
03/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  ID0016 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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