Provider Demographics
NPI:1538845516
Name:RAVI, SAIMANASA
Entity type:Individual
Prefix:
First Name:SAIMANASA
Middle Name:
Last Name:RAVI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11413 BLUE BLOSSOM RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3844
Mailing Address - Country:US
Mailing Address - Phone:971-330-7439
Mailing Address - Fax:
Practice Address - Street 1:9727 E INDEPENDENCE BLVD
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-4625
Practice Address - Country:US
Practice Address - Phone:980-508-0185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2025-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC143761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program