Provider Demographics
NPI:1922699826
Name:AARON REEVES, REEVES SPECIALTY DENTAL CORPORATION
Entity Type:Organization
Organization Name:AARON REEVES, REEVES SPECIALTY DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-263-2454
Mailing Address - Street 1:9323 LAGUNA SPRINGS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-7839
Mailing Address - Country:US
Mailing Address - Phone:916-689-7837
Mailing Address - Fax:
Practice Address - Street 1:2545 E BIDWELL ST STE 100
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-6443
Practice Address - Country:US
Practice Address - Phone:916-689-7837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AARON REEVES, REEVES DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty