Healthcare Provider Details

I. General information

NPI: 1023250057
Provider Name (Legal Business Name): JOHN STANDISH REEVER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 HOSPITAL RD
PLYMOUTH NH
03264-1128
US

IV. Provider business mailing address

9 HOSPITAL RD
PLYMOUTH NH
03264-1128
US

V. Phone/Fax

Practice location:
  • Phone: 603-536-7600
  • Fax: 603-536-4549
Mailing address:
  • Phone: 603-536-7600
  • Fax: 603-536-4549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1159
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number1159
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: