Provider Demographics
NPI:1023405990
Name:REAVES, JOSHUA COLE (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:COLE
Last Name:REAVES
Suffix:
Gender:M
Credentials:DDS
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Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4906 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:SUITE 1501 BUILDING O
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6962
Mailing Address - Country:US
Mailing Address - Phone:337-981-0144
Mailing Address - Fax:337-981-0162
Practice Address - Street 1:4906 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:SUITE 1501 BUILDING O
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6962
Practice Address - Country:US
Practice Address - Phone:337-981-0144
Practice Address - Fax:337-981-0162
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-18
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6470122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist