Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 6716 | NC |
NPI | 1033329941 |
---|---|
Provider Name | Dr. Daniel Raymond Ravel |
First Address | Fayetteville, NC 28314-0345 |
Second Address | Fayetteville, NC 28314-0345 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 08/07/2007 |