Provider Demographics
NPI:1215042122
Name:RAVASSIPOUR, DARREN B (DDS, MS, PC)
Entity type:Individual
Prefix:DR
First Name:DARREN
Middle Name:B
Last Name:RAVASSIPOUR
Suffix:
Gender:M
Credentials:DDS, MS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 STATE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8493
Mailing Address - Country:US
Mailing Address - Phone:541-779-6200
Mailing Address - Fax:541-779-6203
Practice Address - Street 1:3180 STATE ST STE 102
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8493
Practice Address - Country:US
Practice Address - Phone:541-779-6200
Practice Address - Fax:541-779-6203
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD81771223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics