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Organization
REVERE DENTAL PC
Active
Organization
REVERE DENTAL PC
Active
Other names
Revere Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PARUL TRIVEDI (CEO)
(215) 333-0707
Entity
Organization
Contact information
Practice address
7265 REVERE ST, PHILADELPHIA, PA 19149-1429
(215) 333-0707
Mailing address
7265 REVERE ST, PHILADELPHIA, PA 19149-1429
(215) 333-0707
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS020825L
PA
Other
Enumeration date
11/01/2011
Last updated
11/01/2011
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