# SMILE REVIVAL LLC

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

## Provider details

- **NPI number:** 1982561718
- **Authorized official:** ANDREW WHITE (SOLE MANAGER)
- **Authorized official phone:** (859) 810-8320

## Contact information

- **Practice address:** 178 MINI MALL DR, BEREA, KY 40403-1170
- **Practice address phone:** (859) 231-0596
- **Mailing address:** 105 SPRUCE ST, LEXINGTON, KY 40507-2109
- **Mailing address phone:** (859) 231-0596

## Taxonomy

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

## Other

- **Enumeration date:** 01/05/2026
- **Last updated:** 04/13/2026