Revital Dental Pllc

NPI #1437899812 in Temple, Texas

Provider Information

NPI Number: 1437899812
Entity Type: Organization
Organization Name: Revital Dental Pllc
Primary Specialty: Dentist - General Practice
Enumeration Date: Apr 1, 2022
Last Updated: Sep 14, 2023

Practice Location

Address: 4311 S 31ST ST STE 145
City: Temple
State: Texas
ZIP Code: 76502-3346
Phone: (347) 631-0848

Authorized Official

Name: SUMAN KISHORE KONDRAGUNTA, DDS
Title: MEMBER
Phone: (347) 631-0848

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Dental — Dental	261QD0000X
Dentist - General Practice — General Practice	1223G0001X	Primary

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