Individual
DARYL K REAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1245 FULTON AVE, COOS BAY, OR 97420-2895
(541) 888-6433
(541) 888-7505
Mailing address
1245 FULTON AVE, COOS BAY, OR 97420-2895
(541) 888-6433
(541) 888-7505
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D01503
AZ
Other
Enumeration date
07/24/2015
Last updated
07/24/2015
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