REVEILLE DENTAL
NPI: 1477848315
· HOUSTON, TX 77087
· General Practice Dentistry
· NPI assigned 06/17/2011
$868.80
Total Medicaid Paid
Provider Details
| Authorized Official | PHAN, MARY (PRESIDENT) |
| NPI Enumeration Date | 06/17/2011 |
Related Entities
Other providers sharing the same authorized official: PHAN, MARY
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
36 |
$868.80 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
24 |
24 |
$692.40 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$176.40 |