Organization
TEMPLO DENTAL LLC
Active
Other names
Revive Dental
Organization subpart
No
Provider details
NPI number
Authorized official
GABRIELA MOFFETT (CEO)
(305) 905-5474
Entity
Organization
Contact information
Practice address
8333 W MCNAB RD STE 104, TAMARAC, FL 33321-3203
(954) 722-1100
Mailing address
8333 W MCNAB RD STE 104, TAMARAC, FL 33321-3203
(954) 722-1100
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
07/10/2024
Last updated
07/10/2024
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