Healthcare Provider Details

I. General information

NPI: 1851331250
Provider Name (Legal Business Name): DANIEL ROBERT RAVIN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 HANNAFORD DR
SCARBOROUGH ME
04074-9057
US

IV. Provider business mailing address

21 SCHOONER RD
SCARBOROUGH ME
04074-8775
US

V. Phone/Fax

Practice location:
  • Phone: 207-883-7887
  • Fax: 207-883-3202
Mailing address:
  • Phone: 207-885-0878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberME3294
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: