Daryl K Reavis, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

D01503 Issued in AZ

Practice address

1245 Fulton Ave
Coos Bay, OR 97420-2895

Phone

(541) 888-6433

Fax

(541) 888-7505

NPI assigned

Jul 24, 2015

Last updated

Jul 24, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Confederated Tribes of Coos, Lower Umpqua & Siuslaw Indians

  dba Three Rivers Health Center - Coos Bay

  • Primary Care Clinic/Center
  • Coos Bay, OR
  • NPI 1780755454
  NPD (past)
• Confederated Tribes of Coos, Lower Umpqua, & Siuslaw Indians

  dba Three Rivers Health Center - Dental

  • Dental Clinic/Center
  • Coos Bay, OR
  • NPI 1326889023
  NPD (past)

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

{
    "created_epoch": "1437696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437696000000",
    "number": "1518342179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1245 FULTON AVE",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974202895",
            "telephone_number": "541-888-6433",
            "fax_number": "541-888-7505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1245 FULTON AVE",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974202895",
            "telephone_number": "541-888-6433",
            "fax_number": "541-888-7505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REAVIS",
        "first_name": "DARYL",
        "middle_name": "K",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-07-24",
        "last_updated": "2015-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D01503",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Rhonnie Rego
• Laurie C Reis, LCSW
• Joandrea Leigh Renfrow, DMD
• Christina Lee Reyes

• Dentist in Coos Bay, OR
• Providers in Coos Bay, OR by specialty
• Dentist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2015; 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.