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General NPI Number Information
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NPI Number | 1477244507
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Entity Type | Organization
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Legal Business Name | REVE DERMATOLOGY AND AESTHETICS PLLC
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Dates
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Enumeration Date | 05/18/2023
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 9323 PINECROFT DR STE 202
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City | THE WOODLANDS
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State | TX
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Zip | 77380-3750
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Country | US
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Telephone | 832-663-0427
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Fax |
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Provider Business Mailing Address
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Address Line | 3922 HAWAIIAN CT
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City | BAYTOWN
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State | TX
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Zip | 77521-2199
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | OBEN OJONG
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Credential | MD
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Telephone | 614-625-3402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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