Provider Demographics
NPI:1629140314
Name:REAVIS, CHRISTOPHER RAY (DMD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:RAY
Last Name:REAVIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 W GLENDALE AVE
Mailing Address - Street 2:SUITE #102
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-8576
Mailing Address - Country:US
Mailing Address - Phone:602-995-0114
Mailing Address - Fax:602-995-1300
Practice Address - Street 1:1526 W GLENDALE AVE
Practice Address - Street 2:SUITE #102
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-8576
Practice Address - Country:US
Practice Address - Phone:602-995-0114
Practice Address - Fax:602-995-1300
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ50971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice