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General NPI Number Information
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NPI Number | 1912317215
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Entity Type | Organization
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Legal Business Name | MELISSA RAVAGO, D.M.D., P.C.
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Dates
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Enumeration Date | 05/07/2014
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Last Update Date | 05/07/2014
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Provider Practice Location Address
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Address Line | 8400 OSUNA RD NE SUITE 2B
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-2087
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Country | US
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Telephone | 505-292-4616
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Fax |
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Provider Business Mailing Address
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Address Line | 8400 OSUNA RD NE SUITE 2B
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-2087
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Country | US
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Telephone | 505-292-4616
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MELISSA RAVAGO
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Credential | D.M.D.
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Telephone | 505-292-4616
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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 | DD2907
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License Number State | NM
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