Provider Demographics
NPI:1821200726
Name:RAVAEI DENTAL OFFICE
Entity Type:Organization
Organization Name:RAVAEI DENTAL OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RA VAEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-836-0300
Mailing Address - Street 1:PO BOX 330880
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91333-0880
Mailing Address - Country:US
Mailing Address - Phone:310-836-0300
Mailing Address - Fax:
Practice Address - Street 1:13003 VAN NUYS BLVD
Practice Address - Street 2:SUITE H & I
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-8316
Practice Address - Country:US
Practice Address - Phone:310-836-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA419881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty