Provider Demographics
NPI:1295939759
Name:CEDAR PARK PERIODONTICS, PC
Entity type:Organization
Organization Name:CEDAR PARK PERIODONTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:512-528-1400
Mailing Address - Street 1:209 DENALI PASS
Mailing Address - Street 2:SUITE A
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613
Mailing Address - Country:US
Mailing Address - Phone:512-528-1400
Mailing Address - Fax:512-528-1466
Practice Address - Street 1:209 DENALI PASS
Practice Address - Street 2:SUITE A
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613
Practice Address - Country:US
Practice Address - Phone:512-528-1400
Practice Address - Fax:512-528-1466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216531223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty