Revive Dentistry, PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

REVIVE DENTISTRY, PLLC

Practice address

272 E Graves Ave
Orange City, FL 32763-5269

Phone

(386) 775-4300

Fax

(386) 775-0630

NPI assigned

Jan 7, 2026

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Omid Khezri, DDSNPI 1518319250

Title

Dentist

Phone

(765) 631-0659

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Omid Khezri, DDS

  • Dentist
  • Titusville, FL
  • NPI 1518319250
  NPD Authorized official
• James T. Crowther, D.M.D.

  • General Practice Dentistry
  • Orange City, FL
  • NPI 1265480875
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1767744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767744000000",
    "number": "1023975547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "272 E GRAVES AVE",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327635269",
            "telephone_number": "386-775-4300",
            "fax_number": "386-775-0630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "272 E GRAVES AVE",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327635269",
            "telephone_number": "386-775-4300",
            "fax_number": "386-775-0630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE DENTISTRY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-01-07",
        "last_updated": "2026-01-07",
        "certification_date": "2026-01-06",
        "status": "A",
        "authorized_official_last_name": "KHEZRI",
        "authorized_official_first_name": "OMID",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "765-631-0659",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rene Ab Capulong Mdpa
• Raquel Maria Rennie, CRNA
• William M. Rentz, A.R.N.P.
• Restore Injury Health Center
• Gloria Lucia Restrepo Beaux, LMHC
• Susan I. Rey Robles, FNP-C
• Maricelys Reyes
• Randy P Rhames
• Tamica D Rhodes, CNM
• Ana I Ribeiro, ARNP

• Dental Clinic/Center in Orange City, FL
• Providers in Orange City, FL by specialty
• Dental Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.