Provider Demographics
NPI:1659929222
Name:RAVEN, KACI MAREE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KACI
Middle Name:MAREE
Last Name:RAVEN
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 1:8477 E CLARKSON AVE
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:CA
Mailing Address - Zip Code:93662-9482
Mailing Address - Country:US
Mailing Address - Phone:559-816-2522
Mailing Address - Fax:
Practice Address - Street 1:6753 N WILLOW AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5900
Practice Address - Country:US
Practice Address - Phone:559-434-1088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104201122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist