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Individual

DR. ALLEN BLEY REAVIS

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
111 N 5TH ST, ATCHISON, KS 66002-0399
(913) 367-0212
(913) 367-6214
Mailing address
PO BOX 399, 111 N 5TH, ATCHISON, KS 66002-0399
(913) 367-0212
(913) 367-6214

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
14104
MO
1223G0001X
General Practice Dentistry
Primary
6084
KS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
10022285B
KS
01
116750
BCBS
01
9176546
DORAL MEDICAID
KS
Enumeration date
01/25/2006
Last updated
07/08/2007
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