# REVIVE DENTAL STUDIO LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356071617
- **Authorized official:** DR. AZADEH MAY DIANAT DDS (MANAGER)
- **Authorized official phone:** (404) 578-4423

## Contact information

- **Practice address:** 10 W HANOVER AVE STE 101, RANDOLPH, NJ 07869-4221
- **Practice address phone:** (973) 895-4333
- **Mailing address:** 178 N 11TH ST APT 7D, BROOKLYN, NY 11211-1134
- **Mailing address phone:** (404) 578-4423

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 06/10/2022
- **Last updated:** 06/10/2022