| Revital Dental Pllc | |
|
4311 S 31st St Ste 145 Temple TX 76502-3346 | |
| (347) 631-0848 | |
| Not Available |
| Full Name | Revital Dental Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 4311 S 31st St Ste 145, Temple, Texas |
| Authorized Official Name and Position | Suman Kishore Kondragunta (MEMBER) |
| Authorized Official Contact | 3476310848 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Revital Dental Pllc 4311 S 31st St Ste 145 Temple TX 76502-3346 Ph: (347) 631-0848 | Revital Dental Pllc 4311 S 31st St Ste 145 Temple TX 76502-3346 Ph: (347) 631-0848 |
| NPI Number | 1437899812 |
|---|---|
| Provider Enumeration Date | 04/01/2022 |
| Last Update Date | 09/14/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437899812 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
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