Provider Demographics
NPI:1154584415
Name:REEVIS, MONTE A (DMD)
Entity type:Individual
Prefix:DR
First Name:MONTE
Middle Name:A
Last Name:REEVIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 J DAVID JONES PKWY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-2599
Mailing Address - Country:US
Mailing Address - Phone:217-522-9911
Mailing Address - Fax:
Practice Address - Street 1:1301 J DAVID JONES PKWY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-2599
Practice Address - Country:US
Practice Address - Phone:217-522-9911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019020286122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist