MEDICARE: REEVES, D.D.S. AND LAVALLEY, D.D.S., A DENTAL CORPORATION

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1972137271
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REEVES, D.D.S. AND LAVALLEY, D.D.S., A DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	3100 ZINFANDEL DR STE 400
Second Line	:
City	:	RANCHO CORDOVA
State	:	CA
Zip	:	95670-6391
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1310 E BIDWELL ST
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95630-3524
Country	:	US
Telephone Number	:	844-616-5437
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	TREVOR SMITH
Credential	:
Telephone Number	:	916-340-1075

Provider Enumeration Date	:	02/25/2020
Last Update Date	:	02/09/2023

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