# REAVLEY DENTAL

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

## Provider details

- **NPI number:** 1447919840
- **Authorized official:** MS. CAROL D REAVLEY (OFFICE MANAGER)
- **Authorized official phone:** (417) 682-3393

## Contact information

- **Practice address:** 804 GULF STREET, LAMAR, MO 64759-6475
- **Practice address phone:** (417) 682-3393
- **Practice address fax:** (417) 682-6659
- **Mailing address:** 804 GULF STREET, LAMAR, MO 64759
- **Mailing address phone:** (417) 682-3393
- **Mailing address fax:** (417) 683-6659

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/13/2021
- **Last updated:** 12/21/2021