Provider Demographics
NPI:1083786222
Name:MARA, RAVI KIRAN (DDS)
Entity Type:Individual
Prefix:
First Name:RAVI
Middle Name:KIRAN
Last Name:MARA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13899 HIGHWAY 13 S
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-2135
Mailing Address - Country:US
Mailing Address - Phone:952-440-2292
Mailing Address - Fax:952-440-2935
Practice Address - Street 1:13899 HIGHWAY 13 S
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-2135
Practice Address - Country:US
Practice Address - Phone:952-440-2292
Practice Address - Fax:952-440-2935
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND119151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice