Organization Name: | EDWARD N. REITER, D.D.S., INC. |
NPI Number: | 1104847284 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | EDWARD NEIL REITER (PRESIDENT) |
Mailing Address: | 8620 Calmont Ave Ft Worth |
State: | TX US |
Postal Code: | 761162802 |
Phone Number: | 8172446315 |
Fax Number: | 8172444530 |
NPI Enumeration Date: | 07/22/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 9697 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |