Healthcare Provider Details

I. General information

NPI: 1457365694
Provider Name (Legal Business Name): RAVIPAN I SMITH D.D.S., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 WESTMINSTER AVE STE 108
SEAL BEACH CA
90740-5370
US

IV. Provider business mailing address

2999 WESTMINSTER AVE STE 108
SEAL BEACH CA
90740-5370
US

V. Phone/Fax

Practice location:
  • Phone: 562-431-9739
  • Fax: 562-683-0474
Mailing address:
  • Phone: 562-431-9739
  • Fax: 562-683-0474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number46528
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: