MEDICARE: DR. ALLISON ANTOINETTE REEVES DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	3346	SC

General Provider Information

NPI Number	:	1386777159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLISON ANTOINETTE REEVES DMD

Provider Business Mailing Address
First Line	:	PO BOX 3789
Second Line	:	516 WEST LIBERTY STREET
City	:	SUMTER
State	:	SC
Zip	:	29150-4819
Country	:	US
Telephone Number	:	803-773-9300
Fax Number	:	803-773-3556

Provider Business Practice Location Address
First Line	:	516 WEST LIBERTY STREET
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29150-4819
Country	:	US
Telephone Number	:	803-773-9300
Fax Number	:	803-773-3556

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	07/08/2007

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