Provider Demographics
NPI:1477107456
Name:REEVES, D.D.S. AND LAVALLEY, D.D.S., A DENTAL CORPORATION
Entity Type:Organization
Organization Name:REEVES, D.D.S. AND LAVALLEY, D.D.S., A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-444-5437
Mailing Address - Street 1:3100 ZINFANDEL DR STE 400
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-6391
Mailing Address - Country:US
Mailing Address - Phone:323-804-1471
Mailing Address - Fax:
Practice Address - Street 1:2277 FAIR OAKS BLVD STE 330
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-5596
Practice Address - Country:US
Practice Address - Phone:111-111-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental