Organization
SMILE REVIVAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW WHITE (SOLE MANAGER)
(859) 810-8320
Entity
Organization
Contact information
Practice address
178 MINI MALL DR, BEREA, KY 40403-1170
(859) 231-0596
Mailing address
105 SPRUCE ST, LEXINGTON, KY 40507-2109
(859) 231-0596
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
01/05/2026
Last updated
04/13/2026
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