Individual
BRIAN A REAVLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
804 GULF ST, LAMAR, MO 64759-1239
(174) 682-3393
(417) 682-6659
Mailing address
804 GULF ST, LAMAR, MO 64759-1239
(417) 682-3393
(417) 682-6659
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2011016310
MO
Other
Enumeration date
07/20/2011
Last updated
09/07/2021
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