Provider Demographics
NPI:1750109351
Name:REVIVE DENTAL SOLUTIONS PLLC
Entity type:Organization
Organization Name:REVIVE DENTAL SOLUTIONS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:K
Authorized Official - Last Name:LAABS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-545-3010
Mailing Address - Street 1:5727 W 42ND ST
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-3101
Mailing Address - Country:US
Mailing Address - Phone:612-275-1846
Mailing Address - Fax:
Practice Address - Street 1:2775 WINNETKA AVE N
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55427-2830
Practice Address - Country:US
Practice Address - Phone:763-545-3010
Practice Address - Fax:763-595-0543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-01
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental