Provider Demographics
NPI:1023003183
Name:REEVES, TERESA ELLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:ELLEN
Last Name:REEVES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 MDG/SGDD
Mailing Address - Street 2:101 BODIN CIRCLE, TRAVIS AFB
Mailing Address - City:TRAVIS AFB
Mailing Address - State:CA
Mailing Address - Zip Code:94535
Mailing Address - Country:US
Mailing Address - Phone:707-423-7008
Mailing Address - Fax:
Practice Address - Street 1:60 MDG/SGDD
Practice Address - Street 2:101 BODIN CIRCLE, TRAVIS AFB
Practice Address - City:TRAVIS AFB
Practice Address - State:CA
Practice Address - Zip Code:94535
Practice Address - Country:US
Practice Address - Phone:707-423-7008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171121223G0001X, 1223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology
No1223G0001XDental ProvidersDentistGeneral Practice