Provider Demographics
NPI:1417230236
Name:LYNN H REEVE DDS PA
Entity Type:Organization
Organization Name:LYNN H REEVE DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:HELM
Authorized Official - Last Name:REEVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-235-3968
Mailing Address - Street 1:1307 ALBION AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-1850
Mailing Address - Country:US
Mailing Address - Phone:507-235-3968
Mailing Address - Fax:
Practice Address - Street 1:1307 ALBION AVE STE 103
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-1850
Practice Address - Country:US
Practice Address - Phone:507-235-3968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN84891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty