# EAGLE MOUNTIAN FAMILY DENTAL, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376630525
- **Authorized official:** DR. KYLE LARRY REEVES D.D.S. (PRESIDENT SECRETARY TREASURER)
- **Authorized official phone:** (817) 444-3890

## Contact information

- **Practice address:** 116 DENVER TRL, AZLE, TX 76020-3614
- **Practice address phone:** (817) 444-3890
- **Mailing address:** 116 DENVER TRL, AZLE, TX 76020-3614
- **Mailing address phone:** (817) 444-3890

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 20177 | TX | Yes |

## Other

- **Enumeration date:** 10/09/2006
- **Last updated:** 08/22/2020