MEDICARE: MRS. ROBIN SUE REICH D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN010035	GA

General Provider Information

NPI Number	:	1366837783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROBIN SUE REICH D.D.S

Provider Business Mailing Address
First Line	:	4480 H SOUTH COBB DRIVE
Second Line	:	STE. 530
City	:	SMYRNA
State	:	GA
Zip	:	30080-6984
Country	:	US
Telephone Number	:	770-435-5450
Fax Number	:

Provider Business Practice Location Address
First Line	:	4849 SOUTH COBB DRIVE SE
Second Line	:	STE. 111
City	:	SMYRNA
State	:	GA
Zip	:	30080-7145
Country	:	US
Telephone Number	:	770-435-5450
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2015
Last Update Date	:	04/02/2015

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