Provider Demographics
NPI:1720354822
Name:RAGUSA, JOHN BEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BEN
Last Name:RAGUSA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16819 CHERRY BARK DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-5811
Mailing Address - Country:US
Mailing Address - Phone:225-241-7928
Mailing Address - Fax:
Practice Address - Street 1:16819 CHERRY BARK DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-5811
Practice Address - Country:US
Practice Address - Phone:225-241-7928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA21561223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery