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NPI Code Detail

MEDICARE: BRIAN A REAVLEY DDS

MEDICARE: BRIAN A REAVLEY DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist2011016310MO

General Provider Information

NPI Number : 1619265964
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN A REAVLEY DDS
Provider Business Mailing Address
First Line : 804 GULF ST
Second Line :
City : LAMAR
State : MO
Zip : 64759-1239
Country : US
Telephone Number : 417-682-3393
Fax Number : 417-682-6659
Provider Business Practice Location Address
First Line : 804 GULF ST
Second Line :
City : LAMAR
State : MO
Zip : 64759-1239
Country : US
Telephone Number : 174-682-3393
Fax Number : 417-682-6659
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2011
Last Update Date : 09/07/2021

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Directions to “ BRIAN A REAVLEY DDS” Practice Location

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