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Individual

PETER TYLER RAVEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Contact information

Practice address
222 6TH ST, SPRINGFIELD, OR 97477-4602
(541) 726-1961
(541) 726-3926
Mailing address
2216 15TH ST, SPRINGFIELD, OR 97477-2434
(541) 515-6218
(541) 726-3926

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D9085
OR

Other

Enumeration date
09/25/2008
Last updated
09/25/2008
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