Organization
REVIVE DENTAL AESTHETICS LLC
Active
Other names
Revive Dental Aesthetics
Organization subpart
No
Provider details
NPI number
Authorized official
VERONICA GE DMD (OWNER)
(803) 380-8018
Entity
Organization
Contact information
Practice address
2220 DAISY LANE, SUITE D105, INDIAN LAND, SC 29707
(803) 380-8018
(803) 380-8003
Mailing address
2999 HOLBROOK RD, FORT MILL, SC 29715-7034
(803) 380-8018
(803) 380-8003
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/31/2026
Last updated
03/31/2026
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