| NPI | 1871320663 |
|---|---|
| Doing Business As | REVITALIZE DENTAL |
| Entity Type | Organization |
| Authorized Contact | SHEILA SHAIN Practice Director 502-386-7147 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2024-09-17 |
| Last Update Date | 2024-09-17 |