Provider Demographics
NPI:1083055289
Name:PAUL D. REVARD D.D.S.
Entity Type:Organization
Organization Name:PAUL D. REVARD D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:REVARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-893-2140
Mailing Address - Street 1:916 WASHINGTON AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708
Mailing Address - Country:US
Mailing Address - Phone:989-893-2140
Mailing Address - Fax:989-893-2140
Practice Address - Street 1:916 WASHINGTON AVE.
Practice Address - Street 2:SUITE 215
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708
Practice Address - Country:US
Practice Address - Phone:989-893-2140
Practice Address - Fax:989-893-0423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty