Provider Demographics
NPI:1013663400
Name:REAVES PEDIATRIC DENTISTRY, LLC
Entity Type:Organization
Organization Name:REAVES PEDIATRIC DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAITLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:REAVES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-332-8911
Mailing Address - Street 1:2828 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-2504
Mailing Address - Country:US
Mailing Address - Phone:205-332-3886
Mailing Address - Fax:205-332-3887
Practice Address - Street 1:2828 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-2504
Practice Address - Country:US
Practice Address - Phone:205-332-3886
Practice Address - Fax:205-332-3887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty