=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255253068
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REVIVE DENTAL GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2026
-----------------------------------------------------
Last Update Date | 07/27/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 516 MAIN ST
-----------------------------------------------------
City | DELHI
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71232-2538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-680-1608
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 516 MAIN ST
-----------------------------------------------------
City | DELHI
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71232-2538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-680-1608
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO OWNER/DENTIST
-----------------------------------------------------
Name | DR. EMILY LITTLE CASSIS
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 318-680-1608
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------