OrganizationActive
Revive Dentistry, PLLC
NPI 1023975547 · Dental Clinic/Center · Orange City, FL
Provider details
- NPI number
- 1023975547
- Entity type
- Organization
- Primary specialty
- Dental Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Omid Khezri, Dentist(765) 631-0659
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
Established profile(53/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
Under 1 yr in registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
272 E Graves Ave
Orange City, FL 32763-5269
Phone: (386) 775-4300
Fax: (386) 775-0630
Street-level locationGet directions
Mailing address
272 E Graves Ave
Orange City, FL 32763-5269
Registry dates
- Enumerated
- 2026-01-07
- Last updated
- 2026-01-07
- Certified
- 2026-01-06
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.