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General NPI Number Information
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NPI Number | 1437421310
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Entity Type | Organization
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Legal Business Name | REVEL DENTAL,PSC
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Dates
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Enumeration Date | 02/07/2012
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Last Update Date | 02/07/2012
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Provider Practice Location Address
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Address Line | 210 BELLAIRE DR
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City | NICHOLASVILLE
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State | KY
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Zip | 40356-8840
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Country | US
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Telephone | 859-887-3835
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Fax | 859-887-0351
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Provider Business Mailing Address
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Address Line | 210 BELLAIRE DR
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City | NICHOLASVILLE
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State | KY
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Zip | 40356-8840
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Country | US
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Telephone | 895-887-3835
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Fax | 859-887-0351
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Authorized Official
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Title or Position | PRES.
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Name | DR. PAMELA A REVEL
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Credential | DMD
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Telephone | 859-887-3835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7128
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License Number State | KY
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