Provider Demographics
NPI:1093699274
Name:RAVEN, ISABEL (DMD)
Entity type:Individual
Prefix:
First Name:ISABEL
Middle Name:
Last Name:RAVEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6144 PINE CANOPY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-3999
Mailing Address - Country:US
Mailing Address - Phone:305-753-8958
Mailing Address - Fax:
Practice Address - Street 1:964 GLENWAY DR STE A
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-9204
Practice Address - Country:US
Practice Address - Phone:704-252-5793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14417122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist