Provider Demographics
NPI:1477244507
Name:REVE DERMATOLOGY AND AESTHETICS PLLC
Entity Type:Organization
Organization Name:REVE DERMATOLOGY AND AESTHETICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:OJONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-625-3402
Mailing Address - Street 1:3922 HAWAIIAN CT
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-2199
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9323 PINECROFT DR STE 202
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3750
Practice Address - Country:US
Practice Address - Phone:646-630-8588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-18
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty