Provider Demographics
NPI:1942492178
Name:RAVON, NICOLAS ANDREAS (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:ANDREAS
Last Name:RAVON
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3808 W RIVERSIDE DR STE 305
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4339
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3808 W RIVERSIDE DR STE 305
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4339
Practice Address - Country:US
Practice Address - Phone:818-558-7454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-12
Last Update Date:2007-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA445331223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics