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General NPI Number Information
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NPI Number | 1689887218
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Entity Type | Organization
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Legal Business Name | DANIEL R. RAVIN, P.C.
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 40 HANNAFORD DR
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City | SCARBOROUGH
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State | ME
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Zip | 04074-9057
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Country | US
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Telephone | 207-883-7887
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Fax | 207-883-3202
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Provider Business Mailing Address
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Address Line | 21 SCHOONER RD
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City | SCARBOROUGH
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State | ME
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Zip | 04074-8775
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Country | US
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Telephone | 207-885-0878
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DANIEL R. RAVIN
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Credential | D.M.D.
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Telephone | 207-883-7887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 3294
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License Number State | ME
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