Provider Demographics
NPI:1619436334
Name:REESE, JAMES CRAIG SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CRAIG
Last Name:REESE
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2079
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-0040
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HOUSE 81, ROAD 4503, BLOCK 945
Practice Address - Street 2:
Practice Address - City:AWALI
Practice Address - State:SOUTHERN GOVERNANT
Practice Address - Zip Code:00000
Practice Address - Country:BH
Practice Address - Phone:363-276-9849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16537122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX07208006OtherTEXAS DRIVERS LICENSE