Provider Demographics
NPI:1831204007
Name:REEVES, WILLIAM RUDYARD JR (DDS MS PC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RUDYARD
Last Name:REEVES
Suffix:JR
Gender:M
Credentials:DDS MS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2613 E HIGHWAY 377 STE 101
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-6129
Mailing Address - Country:US
Mailing Address - Phone:817-573-8383
Mailing Address - Fax:817-573-8484
Practice Address - Street 1:2613 E HIGHWAY 377 STE 101
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-6129
Practice Address - Country:US
Practice Address - Phone:817-573-8383
Practice Address - Fax:817-573-8484
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19019122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice