Provider Demographics
NPI:1275650459
Name:RAVA, JOSEPH STEPHEN (DMD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:STEPHEN
Last Name:RAVA
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 1:305 N POTTSTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2228
Mailing Address - Country:US
Mailing Address - Phone:610-363-6870
Mailing Address - Fax:
Practice Address - Street 1:305 N POTTSTOWN PIKE
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2228
Practice Address - Country:US
Practice Address - Phone:610-363-6870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027677L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist