Active NPI
Revive Dental Aesthetics LLC
Doing business as Revive Dental Aesthetics
- General Practice Dentistry
- Indian Land, SC
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- Legal business name
- REVIVE DENTAL AESTHETICS LLC
- Doing business as
- Revive Dental Aesthetics
- Practice address
- 2220 Daisy Lane
Suite D105
Indian Land, SC 29707 - Phone
- (803) 380-8018
- Fax
- (803) 380-8003
- NPI assigned
- Apr 1, 2026
- Last updated
- Apr 1, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Veronica Ge, DMD
- Title
- Owner
- Phone
- (803) 380-8018
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | NU | Primary |
Addresses
Primary practice location
2220 Daisy Lane
Suite D105
Indian Land, SC 29707
Mailing address
2999 Holbrook Rd
Fort Mill, SC 29715-7034
Phone (803) 380-8018
Other names 1
- Revive Dental Aesthetics
National Provider Directory
National Provider Directory- Tax ID family
- Revive Dental Aesthetics
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Revive Dental Aesthetics
- General Practice Dentistry
- Indian Land, SC
- NPI 1053251892
Locations
2220 Daisy LN
Ste D105
Indian Land, SC 29707
Phone (803) 380-8018
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- General Practice Dentistry
- Indian Land, SC
- NPI 1134796204
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1775001600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1775001600000",
"number": "1376483917",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2999 HOLBROOK RD",
"city": "FORT MILL",
"state": "SC",
"postal_code": "297157034",
"telephone_number": "803-380-8018",
"fax_number": "803-380-8003"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2220 DAISY LANE",
"address_2": "SUITE D105",
"city": "INDIAN LAND",
"state": "SC",
"postal_code": "29707",
"telephone_number": "803-380-8018",
"fax_number": "803-380-8003"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "REVIVE DENTAL AESTHETICS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2026-04-01",
"last_updated": "2026-04-01",
"certification_date": "2026-03-25",
"status": "A",
"authorized_official_last_name": "GE",
"authorized_official_first_name": "VERONICA",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "803-380-8018",
"authorized_official_credential": "DMD"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Revive Dental Aesthetics",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Indian Land, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 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.