Organization
REVIVAL DERMATOLOGY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA GUIDRY PRUETT MD (PRESIDENT)
(504) 319-1407
Entity
Organization
Contact information
Practice address
8201 PRESTON RD STE 440, DALLAS, TX 75225-6209
(214) 675-3227
(972) 435-4481
Mailing address
8201 PRESTON RD STE 440, DALLAS, TX 75225-6209
(214) 675-3227
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
05/30/2021
Last updated
06/11/2021
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