Provider Demographics
NPI:1770706368
Name:RAVI, PRIYA (DDS)
Entity type:Individual
Prefix:DR
First Name:PRIYA
Middle Name:
Last Name:RAVI
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 1:570 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4744
Mailing Address - Country:US
Mailing Address - Phone:516-503-8958
Mailing Address - Fax:516-935-0192
Practice Address - Street 1:57 N BROADWAY
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-2941
Practice Address - Country:US
Practice Address - Phone:516-935-0236
Practice Address - Fax:516-935-0192
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY499331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice