Provider Demographics
NPI:1669545612
Name:HIRA, RAVNEET (DDS)
Entity type:Individual
Prefix:DR
First Name:RAVNEET
Middle Name:
Last Name:HIRA
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 1:700 STRATFORD LN
Mailing Address - Street 2:UNIT G 154
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2719
Mailing Address - Country:US
Mailing Address - Phone:845-343-7089
Mailing Address - Fax:
Practice Address - Street 1:700 STRATFORD LN
Practice Address - Street 2:UNIT G 154
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2719
Practice Address - Country:US
Practice Address - Phone:845-343-7089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052293122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355931Medicaid
NYW04881Medicare ID - Type UnspecifiedBN
NY00355931Medicaid