Provider Demographics
NPI:1457559056
Name:RAVNER, WARREN (DMD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:
Last Name:RAVNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4507 US HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-3380
Mailing Address - Country:US
Mailing Address - Phone:732-364-1444
Mailing Address - Fax:732-364-9874
Practice Address - Street 1:4507 US HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-3380
Practice Address - Country:US
Practice Address - Phone:732-364-1444
Practice Address - Fax:732-364-9874
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ126301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice