Provider Demographics
NPI:1992842868
Name:RAVENEL ENDODONTICS
Entity Type:Organization
Organization Name:RAVENEL ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:D
Authorized Official - Last Name:RAVENEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-987-7030
Mailing Address - Street 1:1130 E BUTLER RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5908
Mailing Address - Country:US
Mailing Address - Phone:864-987-7030
Mailing Address - Fax:864-987-0198
Practice Address - Street 1:1130 E BUTLER RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5908
Practice Address - Country:US
Practice Address - Phone:864-987-7030
Practice Address - Fax:864-987-0198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37111223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty