Raven Valisha Reese, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN122869 Issued in GA

Practice address

1699 Duluth Hwy
Lawrenceville, GA 30043-5010

Phone

(770) 338-1963

NPI assigned

Sep 22, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jerry E Nutt DDS & Assoc of Lawrenceville

  • General Practice Dentistry
  • Lawrenceville, GA
  • NPI 1508905001
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1663804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663804800000",
    "number": "1255054516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7235 RAND DR",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301355628",
            "telephone_number": "678-387-0249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1699 DULUTH HWY",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300435010",
            "telephone_number": "770-338-1963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REESE",
        "first_name": "RAVEN",
        "middle_name": "VALISHA",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-22",
        "last_updated": "2022-09-22",
        "certification_date": "2022-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN122869",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rediclinic LLC
• Rediclinic LLC
• Jada Redman
• Thaddeus Reecesiri Reece, PSYD
• Tia Rene'E Reed, DC
• Kim Nicole Reeves
• Refining Perceptions
• Region 13 Department of Family and Children SWS
• Kellie Eden Reich, LPC
• Dionne Reid-Hayles, LCSW

• General Practice Dentistry in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.