Provider Demographics
NPI:1235412495
Name:DRUMMOND, RAVEN ALLEGRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAVEN
Middle Name:ALLEGRA
Last Name:DRUMMOND
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 1:882 NOSTRAND AVE
Mailing Address - Street 2:#B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-2249
Mailing Address - Country:US
Mailing Address - Phone:718-756-2213
Mailing Address - Fax:
Practice Address - Street 1:882 NOSTRAND AVE
Practice Address - Street 2:#B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-2249
Practice Address - Country:US
Practice Address - Phone:718-756-2213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50 0557891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice