Individual
DR. JOSE AGUSTIN RAVELO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
5620 BERGENLINE AVE STE 2, WEST NEW YORK, NJ 07093-1257
(201) 861-9400
(201) 861-9199
Mailing address
5620 BERGENLINE AVE STE 2, WEST NEW YORK, NJ 07093-1257
(201) 861-9400
(201) 861-9199
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
046379-1
NY
1223G0001X
General Practice Dentistry
Primary
DI20448
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8453501
—
NJ
Enumeration date
05/31/2006
Last updated
07/26/2019
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