Provider Demographics
NPI:1508255928
Name:REEVES, DDS AND LAVALLEY, DDS, A DENTAL CORPORATION
Entity Type:Organization
Organization Name:REEVES, DDS AND LAVALLEY, DDS, A DENTAL CORPORATION
Other - Org Name:KIDS CARE DENTAL & ORTHODONTICS - PLEASANTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-570-1500
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:916-570-1500
Mailing Address - Fax:
Practice Address - Street 1:4555 HOPYARD RD
Practice Address - Street 2:SUITE C-19
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-2771
Practice Address - Country:US
Practice Address - Phone:916-444-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47785122300000X
1223P0221X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty