Individual
DR. BRADLEY DAVID REVENIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
NAVAL HEALTH CLINIC HAWAII, 480 CENTRAL AVENUE, PEARL HARBOR, HI 96860
(808) 257-3365
Mailing address
21ST DENTAL COMPANY, 3RD DENTAL BN, BLDG 6905, HARRIS AV, KANEOHE BAY, HI 96863
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
9872
AZ
Other
Enumeration date
09/26/2017
Last updated
07/24/2024
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