Provider Demographics
NPI:1760558472
Name:DR MONTE A REEVIS DMD INC
Entity Type:Organization
Organization Name:DR MONTE A REEVIS DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MONTE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:REEVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:217-522-9911
Mailing Address - Street 1:1301 J DAVID JONES PARKWAY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-2599
Mailing Address - Country:US
Mailing Address - Phone:217-522-9911
Mailing Address - Fax:217-522-0052
Practice Address - Street 1:1301 J DAVID JONES PARKWAY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-2599
Practice Address - Country:US
Practice Address - Phone:217-522-9911
Practice Address - Fax:217-522-0052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019020286122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty