Individual
JOHN KENNEDY REVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6035 EXECUTIVE DR, STE 200, LANSING, MI 48911
(517) 887-7200
(517) 887-1549
Mailing address
2123 BEACON HILL DR, LANSING, MI 48906
(517) 887-7200
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901016303
MI
Other
Enumeration date
10/31/2006
Last updated
07/08/2007
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