Provider Demographics
NPI:1407213655
Name:GEOFFREY REEVES D.D.S.
Entity Type:Organization
Organization Name:GEOFFREY REEVES D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTISTRY/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:STPHEN
Authorized Official - Last Name:REVES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS/PC
Authorized Official - Phone:517-784-0897
Mailing Address - Street 1:2002 SPRING ARBOR RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-2888
Mailing Address - Country:US
Mailing Address - Phone:517-784-0897
Mailing Address - Fax:517-784-1650
Practice Address - Street 1:2002 SPRING ARBOR RD
Practice Address - Street 2:SUITE B
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-2888
Practice Address - Country:US
Practice Address - Phone:517-784-0897
Practice Address - Fax:517-784-1650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI147371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty