Provider Demographics
NPI:1447476353
Name:REEVES, KYLE LARRY (DDS)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:LARRY
Last Name:REEVES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 DENVER TRL
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-3614
Mailing Address - Country:US
Mailing Address - Phone:817-444-3890
Mailing Address - Fax:817-270-4746
Practice Address - Street 1:116 DENVER TRL
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-3614
Practice Address - Country:US
Practice Address - Phone:817-444-3890
Practice Address - Fax:817-270-4746
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice