Peter Tyler Raven, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D9085 Issued in OR

Practice address

222 6TH St
Springfield, OR 97477-4602

Phone

(541) 726-1961

Fax

(541) 726-3926

NPI assigned

Sep 25, 2008

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Peter T Raven DDS LLC

  • Dental Clinic/Center
  • Springfield, OR
  • NPI 1619264272
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1222300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222300800000",
    "number": "1700036878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2216 15TH ST",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974772434",
            "telephone_number": "541-515-6218",
            "fax_number": "541-726-3926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 6TH ST",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974774602",
            "telephone_number": "541-726-1961",
            "fax_number": "541-726-3926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAVEN",
        "first_name": "PETER",
        "middle_name": "TYLER",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-09-25",
        "last_updated": "2008-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D9085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittney M Rasmussen, MAT
• Nicholas Ward Rasmussen, M.A.
• Renee Rathke, MSW, L.C.S.W.
• Molly Elisabeth Raths, GCG
• Erika Marie Rauer
• Sandra Re
• Kirstin Rea
• Sarah E Reading, PA-C
• Katherine Fitzpatrick Ready, M.D.
• Dinesh K Reddy, D.M.D., M.S.

• General Practice Dentistry in Springfield, OR
• Providers in Springfield, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.