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General NPI Number Information
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NPI Number | 1669511010
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Entity Type | Individual
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Provider Name | RAVI JAY RAJANNA DMD
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Gender | Male
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 01/25/2023
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Provider Practice Location Address
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Address Line | 1399 NE DOUGLAS ST
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City | LEES SUMMIT
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State | MO
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Zip | 64086-4607
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Country | US
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Telephone | 816-373-0300
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Fax | 816-373-1411
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Provider Business Mailing Address
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Address Line | 1399 NE DOUGLAS ST
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City | LEES SUMMIT
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State | MO
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Zip | 64086-4607
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Country | US
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Telephone | 816-373-0300
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Fax | 816-373-1411
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2005031231
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 09238
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 60913
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License Number State | KS
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Taxonomy #4
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2005031231
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License Number State | MO
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