Healthcare Provider Details

I. General information

NPI: 1558442905
Provider Name (Legal Business Name): DOUGLAS H REAMS DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6075 EAST HIGHWAY 20
LUCERNE CA
95458
US

IV. Provider business mailing address

PO BOX 1134
LUCERNE CA
95458-1134
US

V. Phone/Fax

Practice location:
  • Phone: 707-274-6605
  • Fax: 707-274-8227
Mailing address:
  • Phone: 707-274-6605
  • Fax: 707-274-8227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number26910
License Number StateCA

VIII. Authorized Official

Name: DR. DOUGLAS H REAMS
Title or Position: PRESIDENT
Credential: DDS
Phone: 707-274-6605