Provider Demographics
NPI:1851707178
Name:REEVES, D.D.S. AND LAVALLEY, D.D.S., A DENTAL CORPORATION
Entity Type:Organization
Organization Name:REEVES, D.D.S. AND LAVALLEY, D.D.S., A DENTAL CORPORATION
Other - Org Name:KIDS CARE DENTAL & ORTHODONTICS - NATOMAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
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:916-469-2315
Practice Address - Street 1:4670 NATOMAS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95835-1217
Practice Address - Country:US
Practice Address - Phone:916-575-7701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-08
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47785122300000X
1223P0221X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty