Provider Demographics
NPI:1063633907
Name:RAVAEI, RAMIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAMIN
Middle Name:
Last Name:RAVAEI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 S LA CIENEGA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-4600
Mailing Address - Country:US
Mailing Address - Phone:310-836-0300
Mailing Address - Fax:310-600-5909
Practice Address - Street 1:1835 S LA CIENEGA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-4600
Practice Address - Country:US
Practice Address - Phone:310-836-0300
Practice Address - Fax:310-600-5909
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41988122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist