Provider Demographics
NPI:1003983073
Name:REESE, ROYCE WILLARD SR (DDS)
Entity Type:Individual
Prefix:MR
First Name:ROYCE
Middle Name:WILLARD
Last Name:REESE
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8525 BOAT CLUB RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179
Mailing Address - Country:US
Mailing Address - Phone:817-500-5288
Mailing Address - Fax:817-500-5288
Practice Address - Street 1:8525 BOAT CLUB RD
Practice Address - Street 2:REESE DENTAL AT LAKE COUNTRY, PLLC
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179
Practice Address - Country:US
Practice Address - Phone:817-500-5288
Practice Address - Fax:817-500-5288
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice