Healthcare Provider Details

I. General information

NPI: 1952520884
Provider Name (Legal Business Name): D. REEVES & R. IWASIUK, D.D.S., LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 04/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5420 KIETZKE LANE SUITE 100
RENO NV
89511
US

IV. Provider business mailing address

5420 KIETZKE LANE SUITE 100
RENO NV
89511
US

V. Phone/Fax

Practice location:
  • Phone: 775-825-5221
  • Fax: 775-823-9824
Mailing address:
  • Phone: 775-825-5221
  • Fax: 775-823-9824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: CHERYL A. FRAGA
Title or Position: PRACTICE MANAGER
Credential: CDA
Phone: 775-825-5221