Michael John Revenig, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS0000002186 Issued in TN

Practice address

4601 Brainerd Rd
Chattanooga, TN 37411-3826

Phone

(423) 698-6005

Fax

(423) 698-6410

NPI assigned

Jan 1, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1167609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1487711545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 BRAINERD RD",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374113826",
            "telephone_number": "423-698-6005",
            "fax_number": "423-698-6410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4601 BRAINERD RD",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374113826",
            "telephone_number": "423-698-6005",
            "fax_number": "423-698-6410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REVENIG",
        "first_name": "MICHAEL",
        "middle_name": "JOHN",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "DS0000002186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paige Retkowski, APRN
• Brian Reuhland, M.D.
• Shawn Virginia Reuss, NP
• Rachel Ann Reuther, MA RDN
• Haritha Revana, MD
• Revive Dental Tennessee
• Rex E Rader Jr DDS PC
• Danila Reyes, LPC-MHSP
• Gregory Michael Reyes, M.D.
• Taylor Leigh Reyneke

• General Practice Dentistry in Chattanooga, TN
• Providers in Chattanooga, TN by specialty
• General Practice Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.