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General NPI Number Information
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NPI Number | 1447919840
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Entity Type | Organization
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Legal Business Name | REAVLEY DENTAL
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Dates
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Enumeration Date | 12/13/2021
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Last Update Date | 12/21/2021
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Provider Practice Location Address
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Address Line | 804 GULF STREET
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City | LAMAR
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State | MO
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Zip | 64759-6475
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Country | US
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Telephone | 417-682-3393
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Fax | 417-682-6659
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Provider Business Mailing Address
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Address Line | 804 GULF STREET
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City | LAMAR
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State | MO
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Zip | 64759
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Country | US
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Telephone | 417-682-3393
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Fax | 417-683-6659
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. CAROL D REAVLEY
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Credential |
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Telephone | 417-682-3393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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