1629132501 NPI number — DR. MICHAEL ADAM RAVENS D.M.D.

Table of content: DR. MICHAEL ADAM RAVENS D.M.D. (NPI 1629132501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629132501 NPI number — DR. MICHAEL ADAM RAVENS D.M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAVENS
Provider First Name:
MICHAEL
Provider Middle Name:
ADAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629132501
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PSC 557
Provider Second Line Business Mailing Address:
BOX 3176
Provider Business Mailing Address City Name:
FPO
Provider Business Mailing Address State Name:
AP
Provider Business Mailing Address Postal Code:
96379
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3D DENTAL BATTALION
Provider Second Line Business Practice Location Address:
UNIT 38450
Provider Business Practice Location Address City Name:
FPO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
16178488070
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2006

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:  21606 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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