Provider Demographics
NPI:1720193303
Name:CREVOISIER, RALPH A (DDS MSD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:A
Last Name:CREVOISIER
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14107 COUNTRY VALE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-2354
Mailing Address - Country:US
Mailing Address - Phone:210-464-4678
Mailing Address - Fax:210-495-4411
Practice Address - Street 1:8110 WINDWAY DR
Practice Address - Street 2:
Practice Address - City:WINDCREST
Practice Address - State:TX
Practice Address - Zip Code:78239-2433
Practice Address - Country:US
Practice Address - Phone:210-653-9227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76631223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
7663OtherTEXAS LICENSE 7663