Organization
PETER T RAVEN DDS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER TYLER RAVEN DDS (MANAGER)
(541) 726-1961
Entity
Organization
Contact information
Practice address
222 6TH ST, SPRINGFIELD, OR 97477-4602
(541) 726-1961
Mailing address
222 6TH ST, SPRINGFIELD, OR 97477-4602
(541) 726-1961
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D9085
OR
Other
Enumeration date
07/05/2011
Last updated
07/05/2011
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