| NPI | 1396458857 |
|---|---|
| Doing Business As | REVIVE DENTAL |
| Entity Type | Organization |
| Authorized Contact | RONISHA DURHAM Owner/Dentist 405-569-2604 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2022-12-29 |
| Last Update Date | 2022-12-29 |