Provider Demographics
NPI:1194603928
Name:LANDRY, RAVEN (DDS)
Entity type:Individual
Prefix:
First Name:RAVEN
Middle Name:
Last Name:LANDRY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 N SAM HOUSTON PKWY E APT 8102
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-4608
Mailing Address - Country:US
Mailing Address - Phone:832-257-1071
Mailing Address - Fax:
Practice Address - Street 1:10763 EASTEX FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77093-4301
Practice Address - Country:US
Practice Address - Phone:281-501-2060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41928122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty