Revere Dental PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS020825L Issued in PA

Legal business name

REVERE DENTAL PC

Doing business as

Revere Dental

Practice address

7265 Revere St
Philadelphia, PA 19149-1429

Phone

(215) 333-0707

NPI assigned

Nov 1, 2011

Last updated

Nov 1, 2011By 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

Ms. Parul Trivedi

Title

Ceo

Phone

(215) 333-0707

Specialties & licenses 1

Addresses

Other names 1

• Revere Dental Doing business as

Locations

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

{
    "created_epoch": "1320105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320105600000",
    "number": "1457637654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7265 REVERE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191491429",
            "telephone_number": "215-333-0707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7265 REVERE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191491429",
            "telephone_number": "215-333-0707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVERE DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-01",
        "last_updated": "2011-11-01",
        "status": "A",
        "authorized_official_last_name": "TRIVEDI",
        "authorized_official_first_name": "PARUL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "215-333-0707",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS020825L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revere Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2011; 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.