Provider Demographics
NPI:1356445993
Name:RAVIN, ANNA (DDS)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:RAVIN
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 1:155 MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-3126
Mailing Address - Country:US
Mailing Address - Phone:860-646-1515
Mailing Address - Fax:860-646-5092
Practice Address - Street 1:155 MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-3126
Practice Address - Country:US
Practice Address - Phone:860-646-1515
Practice Address - Fax:860-646-5092
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT90001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice