Organization
REVIVE DENTAL STUDIO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AZADEH MAY DIANAT DDS (MANAGER)
(404) 578-4423
Entity
Organization
Contact information
Practice address
10 W HANOVER AVE STE 101, RANDOLPH, NJ 07869-4221
(973) 895-4333
Mailing address
178 N 11TH ST APT 7D, BROOKLYN, NY 11211-1134
(404) 578-4423
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
06/10/2022
Last updated
06/10/2022
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