Individual
MICHAEL JOHN REVENIG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4601 BRAINERD RD, CHATTANOOGA, TN 37411-3826
(423) 698-6005
(423) 698-6410
Mailing address
4601 BRAINERD RD, CHATTANOOGA, TN 37411-3826
(423) 698-6005
(423) 698-6410
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS0000002186
TN
Other
Enumeration date
01/01/2007
Last updated
07/08/2007
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