| Revive Dental Studio Llc | |
|
10 W Hanover Ave Ste 101 Randolph NJ 07869-4221 | |
| (973) 895-4333 | |
| Not Available |
| Full Name | Revive Dental Studio Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 10 W Hanover Ave Ste 101, Randolph, New Jersey |
| Authorized Official Name and Position | Azadeh May Dianat (MANAGER) |
| Authorized Official Contact | 4045784423 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive Dental Studio Llc 178 N 11th St Apt 7d Brooklyn NY 11211-1134 Ph: (404) 578-4423 | Revive Dental Studio Llc 10 W Hanover Ave Ste 101 Randolph NJ 07869-4221 Ph: (973) 895-4333 |
| NPI Number | 1356071617 |
|---|---|
| Provider Enumeration Date | 06/10/2022 |
| Last Update Date | 06/10/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356071617 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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