Provider Demographics
NPI:1558507541
Name:REEVES, DDS, PS
Entity Type:Organization
Organization Name:REEVES, DDS, PS
Other - Org Name:DES MOINES DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-824-2804
Mailing Address - Street 1:21904 MARINE VIEW DR S
Mailing Address - Street 2:SUITE A
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-6103
Mailing Address - Country:US
Mailing Address - Phone:206-824-2804
Mailing Address - Fax:206-824-4386
Practice Address - Street 1:21904 MARINE VIEW DR S
Practice Address - Street 2:SUITE A
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-6103
Practice Address - Country:US
Practice Address - Phone:206-824-2804
Practice Address - Fax:206-824-4386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000051961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty