Provider Demographics
NPI:1922080225
Name:REEVES, ROGERS COLYER (DMD)
Entity Type:Individual
Prefix:MR
First Name:ROGERS
Middle Name:COLYER
Last Name:REEVES
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 1:159 WENTWORTH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-1731
Mailing Address - Country:US
Mailing Address - Phone:843-577-2898
Mailing Address - Fax:843-577-4464
Practice Address - Street 1:159 WENTWORTH ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-1731
Practice Address - Country:US
Practice Address - Phone:843-577-2898
Practice Address - Fax:843-577-4464
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
513026OtherUNITED CONCORDIA INS