Provider Demographics
NPI:1043296239
Name:RAVENS, FRED J III (DDS)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:J
Last Name:RAVENS
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 ASH ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-3623
Mailing Address - Country:US
Mailing Address - Phone:781-944-0464
Mailing Address - Fax:781-942-9440
Practice Address - Street 1:198 ASH ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-3623
Practice Address - Country:US
Practice Address - Phone:781-944-0464
Practice Address - Fax:781-942-9440
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA139481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice