Individual
ROBERT KENNEDY REVERE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6 LAKELAND CIRCLE, JACKSON, MS 39216
(601) 366-6177
Mailing address
6 LAKELAND CIRCLE, JACKSON, MS 39216
(601) 366-6177
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
168075
MS
Other
Enumeration date
01/22/2007
Last updated
07/08/2007
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