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Organization

REVIVE DENTAL TENNESSEE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MACKENZIE MARIE KEITH (DIRECTOR OF OPERATIONS)
(706) 483-5995
Entity
Organization

Contact information

Practice address
1212 DODDS AVE, CHATTANOOGA, TN 37404-4754
(423) 206-9641
Mailing address
1212 DODDS AVE, CHATTANOOGA, TN 37404-4754

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary

Other

Enumeration date
01/06/2025
Last updated
01/06/2025
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