| Organization Name: | REAVES DENTAL PRACTICE, PLLC |
| NPI Number: | 1124264866 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JUSTIN J REAVES (OWNER - GENERAL DENTIST) |
| Mailing Address: | 4301 Middle Settlement Rd New Hartford |
| State: | NY US |
| Postal Code: | 134135317 |
| Phone Number: | 3157360139 |
| Fax Number: | 3157686148 |
| NPI Enumeration Date: | 12/31/2008 |
| NPI Last Update Date: | 11/05/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 032955 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |