MEDICARE: CHRISTOPHER RAY REAVIS D.M.D

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	1223G0001X	General Practice Dentistry	5097	AZ

General Provider Information

NPI Number	:	1629140314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER RAY REAVIS D.M.D

Provider Business Mailing Address
First Line	:	1526 W GLENDALE AVE
Second Line	:	SUITE #102
City	:	PHOENIX
State	:	AZ
Zip	:	85021-8576
Country	:	US
Telephone Number	:	602-995-0114
Fax Number	:	602-995-1300

Provider Business Practice Location Address
First Line	:	1526 W GLENDALE AVE
Second Line	:	SUITE #102
City	:	PHOENIX
State	:	AZ
Zip	:	85021-8576
Country	:	US
Telephone Number	:	602-995-0114
Fax Number	:	602-995-1300

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	07/08/2007

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