Provider Demographics
NPI:1215927413
Name:RAVIZZA, RICHARD JOSEPH V (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOSEPH
Last Name:RAVIZZA
Suffix:V
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 1:1795 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2093
Mailing Address - Country:US
Mailing Address - Phone:408-286-0617
Mailing Address - Fax:408-286-0696
Practice Address - Street 1:1795 PARK AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2093
Practice Address - Country:US
Practice Address - Phone:408-286-0617
Practice Address - Fax:408-286-0696
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25973122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist