Revival Dentistry LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

REVIVAL DENTISTRY LLC

Practice address

7132 W 127TH St
Palos Heights, IL 60463-1560

Phone

(309) 207-0112

NPI assigned

Jan 8, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Zachary Young, DDS

Title

Dentist/Owner

Phone

(309) 207-0112

Specialties & licenses 1

Addresses

Other names 1

• Palos Family Dental Doing business as

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

{
    "created_epoch": "1578441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578441600000",
    "number": "1487294351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7132 W 127TH ST",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604631560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7132 W 127TH ST",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604631560",
            "telephone_number": "309-207-0112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVAL DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-08",
        "last_updated": "2020-01-08",
        "certification_date": "2020-01-08",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "ZACHARY",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "309-207-0112",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Palos Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bernadette Regganie, MSW, CCM
• Allison Marie Reid, APRN
• Margaret Ann Reif, LCSW
• Renata J Variakojis MD SC
• Renata Variakojis MDSC
• David Reyes, PA-C
• Mark Reyes Sr.
• Monika Aneta Reyes, NP
• Kyle Elizabeth Reynolds, MD
• Robert A Rice, DC

• Dentist in Palos Heights, IL
• Providers in Palos Heights, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2020; 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.