Healthcare Provider Details

I. General information

NPI: 1417585647
Provider Name (Legal Business Name): REEVES, D.D.S. AND LAVALLEY, D.D.S., A DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1361 S LOWER SACRAMENTO RD STE 605
LODI CA
95242-9296
US

IV. Provider business mailing address

3100 ZINFANDEL DR STE 400
RANCHO CORDOVA CA
95670-6391
US

V. Phone/Fax

Practice location:
  • Phone: 844-616-5437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: TREVOR SMITH
Title or Position: CFO
Credential:
Phone: 916-340-1075