MEDICARE: DR. THOMAS J RAVIN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	06714	CT

General Provider Information

NPI Number	:	1275787111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS J RAVIN DMD

Provider Business Mailing Address
First Line	:	365 MAIN STREET
Second Line	:
City	:	WATERTOWN
State	:	CT
Zip	:	06795
Country	:	US
Telephone Number	:	860-274-1051
Fax Number	:	860-274-9595

Provider Business Practice Location Address
First Line	:	365 MAIN ST
Second Line	:
City	:	WATERTOWN
State	:	CT
Zip	:	06795-2249
Country	:	US
Telephone Number	:	860-274-1051
Fax Number	:	860-274-9595

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2008
Last Update Date	:	11/05/2008

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