Healthcare Provider Details

I. General information

NPI: 1265884357
Provider Name (Legal Business Name): KATELYN OLENICH REEVES DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 03/30/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 OAK TREE LN STE 100
DAKOTA DUNES SD
57049-5506
US

IV. Provider business mailing address

411 GLEN EAGLE CT
DAKOTA DUNES SD
57049-5164
US

V. Phone/Fax

Practice location:
  • Phone: 605-242-4700
  • Fax:
Mailing address:
  • Phone: 402-649-1511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number11091
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDDS-09836
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: