# REVEL DENTAL,PSC

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

## Provider details

- **NPI number:** 1437421310
- **Authorized official:** DR. PAMELA A REVEL DMD (PRES.)
- **Authorized official phone:** (859) 887-3835

## Contact information

- **Practice address:** 210 BELLAIRE DR, NICHOLASVILLE, KY 40356-8840
- **Practice address phone:** (859) 887-3835
- **Practice address fax:** (859) 887-0351
- **Mailing address:** 210 BELLAIRE DR, NICHOLASVILLE, KY 40356-8840
- **Mailing address phone:** (895) 887-3835
- **Mailing address fax:** (859) 887-0351

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 7128 | KY | Yes |

## Other

- **Enumeration date:** 02/07/2012
- **Last updated:** 02/07/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7100186980 | — | KY |