Provider Demographics
NPI:1710384102
Name:RAVI, BHAVANA (DDS)
Entity Type:Individual
Prefix:
First Name:BHAVANA
Middle Name:
Last Name:RAVI
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 1:1033 WHITMER CT
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-4530
Mailing Address - Country:US
Mailing Address - Phone:408-802-6962
Mailing Address - Fax:
Practice Address - Street 1:1560 GEER RD
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-3233
Practice Address - Country:US
Practice Address - Phone:209-634-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64152122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist