Revital Dental PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

REVITAL DENTAL PLLC

Practice address

4311 S 31St St Ste 145
Temple, TX 76502-3346

Phone

(347) 631-0848

NPI assigned

Apr 1, 2022

Last updated

Sep 14, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Suman Kishore Kondragunta, DDS

Title

Member

Phone

(347) 631-0848

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1648771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694649600000",
    "number": "1437899812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4311 S 31ST ST STE 145",
            "city": "TEMPLE",
            "state": "TX",
            "postal_code": "765023346",
            "telephone_number": "347-631-0848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4311 S 31ST ST STE 145",
            "city": "TEMPLE",
            "state": "TX",
            "postal_code": "765023346",
            "telephone_number": "347-631-0848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITAL DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-01",
        "last_updated": "2023-09-14",
        "certification_date": "2023-09-14",
        "status": "A",
        "authorized_official_last_name": "KONDRAGUNTA",
        "authorized_official_first_name": "SUMAN",
        "authorized_official_middle_name": "KISHORE",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "347-631-0848",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Debra Reiss, MS CCC-SLP
• Renal Treatment Centers Southeast LP (Temple Dialysis)
• Julie Reneau, PA-C
• George J. Resendes, M.D.
• Chad Retzloff
• Araceli Ocomen Revote, M.D.
• Carlos Angel Reyes Jr., OTD
• Kellie Denice Reyna, PA-C
• Lauren Ashley Reynaga, CTRS
• Ann P. Reynolds, LPC LMFT

• General Practice Dentistry in Temple, TX
• Providers in Temple, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2023; 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.