Active NPI
Kaci Maree Raven, DDS
- Dentist
- Fresno, CA
National Provider Identifier
1659929222
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 104201
- Practice address
- 6753 N Willow Ave
Fresno, CA 93710-5900 - Phone
- (559) 434-1088
- NPI assigned
- Aug 27, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 104201 | CA | Primary |
Addresses
Primary practice location
6753 N Willow Ave
Fresno, CA 93710-5900
Mailing address
8477 E Clarkson Ave
Selma, CA 93662-9482
Phone (559) 816-2522
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 104201 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Willow Sleep Health Dental Group, SE Anderson, DDS Inc. | Current | Accepting new patients | |
| Willow Dental Group | Dentist | Past | Accepting new patients |
Locations
6753 N Willow Ave
Fresno, CA 93710
Phone (559) 424-1088
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dental Clinic/Center
- Fresno, CA
- NPI 1487233615
-
- Dentist
- Fresno, CA
- NPI 1043610165
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1566864000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566864000000",
"number": "1659929222",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8477 E CLARKSON AVE",
"city": "SELMA",
"state": "CA",
"postal_code": "936629482",
"telephone_number": "559-816-2522"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6753 N WILLOW AVE",
"city": "FRESNO",
"state": "CA",
"postal_code": "937105900",
"telephone_number": "559-434-1088"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAVEN",
"first_name": "KACI",
"middle_name": "MAREE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-08-27",
"last_updated": "2019-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "104201",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.