Organization
RAVENEL PERIODONTICS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA SHERWOOD RAVENEL DMD (OWNER/DENTIST)
(864) 626-4777
Entity
Organization
Contact information
Practice address
1130 E BUTLER RD, GREENVILLE, SC 29607-5908
(864) 626-4777
(864) 626-4779
Mailing address
PO BOX 938, MAULDIN, SC 29662-0938
(864) 626-4777
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
07/12/2019
Last updated
07/12/2019
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