Provider Demographics
NPI:1720292147
Name:REEVES, JUSTIN TODD (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:TODD
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 1:111 VILLAGE ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-6477
Mailing Address - Country:US
Mailing Address - Phone:205-991-9997
Mailing Address - Fax:205-991-9925
Practice Address - Street 1:111 VILLAGE ST
Practice Address - Street 2:SUITE 106
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-6477
Practice Address - Country:US
Practice Address - Phone:205-991-9997
Practice Address - Fax:205-991-9925
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL47321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice