RAEVEN B KEENE (NPI# 1356996920) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356996920 |
| Entity Type | Individual |
| Full Name | RAEVEN B KEENE |
| Practice Address |
80 Phoenix Ave Waterbury CT 06702-1418 |
| Practice Telephone | 2037568021 |
| Enumeration Date | 2019-08-09 |
| Last Update Date | 2019-08-09 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 124Q00000X | Dental Hygienist | 008937 | CT | Dental Providers |
| Street Address |
80 PHOENIX AVE |
| City | WATERBURY |
| State | CT |
| Zip Code | 06702-1418 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497756902 | Michael Bass | Dentist | 80 Phoenix Ave, Suite #102, Waterbury, CT 06702-1418 | 2005-08-09 |
| 1578022166 | Daedly Potusek | Nurse Practitioner | 80 Phoenix Ave, Waterbury, CT 06702-1418 | 2019-03-14 |
| 1598239873 | Ashley Corso | Dental Hygienist | 80 Phoenix Ave, Waterbury, CT 06702-1418 | 2019-01-19 |
| 1326510801 | Monica Rose Depaolo | Dental Hygienist | 80 Phoenix Ave, Waterbury, CT 06702-1418 | 2018-12-21 |
| 1023536232 | Courtney Dowen | Nurse Practitioner | 80 Phoenix Ave, Waterbury, CT 06702-1418 | 2017-09-07 |
| 1851834147 | Lindsey Maloney | Nurse Practitioner | 80 Phoenix Ave, Waterbury, CT 06702-1418 | 2016-11-18 |
| 1063864346 | Miguel Mantilla | Internal Medicine | 80 Phoenix Ave, Waterbury, CT 06702-1418 | 2016-07-11 |
| 1124477518 | George Gogas | Social Worker | 80 Phoenix Ave, Suite 201, Waterbury, CT 06702-1418 | 2016-06-07 |
| 1649626300 | Irene Maturo | Dental Hygienist | 80 Phoenix Ave, Suite 201, Waterbury, CT 06702-1418 | 2016-05-11 |
| 1821465170 | Josseelaine Diaz | Dental Hygienist | 80 Phoenix Ave, Waterbury, CT 06702-1418 | 2015-08-21 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780120295 | Melitza Velez | Counselor | 80 Prospect St., Waterbury, CT 06702 | 2017-01-09 |
| 1467813600 | Ashley Joseph | Counselor | 30 Holmes Ave, Waterbury, CT 06702 | 2016-03-16 |
| 1649662313 | Lori Arens | Social Worker | 141 E Main St Fl 4, Waterbury, CT 06702 | 2015-03-04 |
| 1265725584 | Zelda Shleifer | Audiologist | 21 W Main St Fl Place-3, Waterbury, CT 06702 | 2011-05-19 |
| 1700024585 | Charlene Angela Jurgaitis | Durable Medical Equipment & Medical Supplies | 102 Grand Street, Waterbury, CT 06702 | 2009-02-02 |
| 1518090570 | Nathan Z Imre | Pharmacist | 161 East Main St Central Pharmacy, Waterbury, CT 06702 | 2007-03-13 |
| 1922149467 | Rachael A Petitti | Social Worker | 402 East Main Street, Waterbury, CT 06702 | 2007-02-09 |
| 1710024484 | Abbot Terrace Health Center | Assisted Living Facility | 44 Abbott Terrace, Waterbury, CT 06702 | 2007-01-31 |
| 1205994555 | Michael Arcangel Padilla | Social Worker | Western Connecticut Mental Health Network, 55 West Main Street Suite 410, Waterbury, CT 06702 | 2006-12-05 |
| 1205902723 | Colette M Anderson | Social Worker | 55 West Main St Suite 410, Western Connecticut Mental Health Network, Waterbury, CT 06702 | 2006-11-27 |
| Find all providers in zip 06702 | ||||
| Taxonomy Code | 124Q00000X |
| Grouping | Dental Providers |
| Classification | Dental Hygienist |
| An individual who has completed an accredited dental hygiene education program, and an individual who has been licensed by a state board of dental examiners to provide preventive care services under the supervision of a dentist. Functions that may be legally delegated to the dental hygienist vary based on the needs of the dentist, the educational preparation of the dental hygienist and state dental practice acts and regulations, but always include, at a minimum, scaling and polishing the teeth. To avoid misleading the public, no occupational title other than dental hygienist should be used to describe this dental auxiliary. |
| Notes: Source: Comprehensive Policy Statement on Dental Auxiliaries, American Dental Association. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043688930 | Katelyn Bartone | Dental Hygienist | 80 Phoenix Ave Ste 201, Waterbury, CT 06702-1418 | 2015-09-09 |
| 1780685610 | Paula Magalhaes Coelho | Dental Hygienist | 1302 S Main St, Waterbury, CT 06706-1748 | 2005-08-02 |
| 1568017671 | Debora Rocha Donascimento-silva | Dental Hygienist | 1302 S Main St, Waterbury, CT 06706-1748 | 2019-08-06 |
| 1598239873 | Ashley Corso | Dental Hygienist | 80 Phoenix Ave, Waterbury, CT 06702-1418 | 2019-01-19 |
| 1326510801 | Monica Rose Depaolo | Dental Hygienist | 80 Phoenix Ave, Waterbury, CT 06702-1418 | 2018-12-21 |
| 1427530575 | Amy L Backstrom | Dental Hygienist | 1302 S Main St, Waterbury, CT 06706-1748 | 2018-09-05 |
| 1033647243 | Ezequiel Alvarez-figueroa | Dental Hygienist | 1302 S Main St, Waterbury, CT 06706-1748 | 2017-06-01 |
| 1972044832 | Angel M. Laplante | Dental Hygienist | 1302 S Main St, Waterbury, CT 06706-1748 | 2017-03-12 |
| 1649626300 | Irene Maturo | Dental Hygienist | 80 Phoenix Ave, Suite 201, Waterbury, CT 06702-1418 | 2016-05-11 |
| 1033580337 | Sonila Alickolli | Dental Hygienist | 1302 S Main St, Waterbury, CT 06706-1748 | 2015-10-13 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.