MEDICARE: DR. MICHAEL REIDY

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	30.026823	OH
2	1223G0001X	General Practice Dentistry	30.026823	OH

General Provider Information

NPI Number	:	1629715305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL REIDY

Provider Business Mailing Address
First Line	:	1055 NIMITZVIEW DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-4359
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1055 NIMITZVIEW DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-4359
Country	:	US
Telephone Number	:	513-231-5353
Fax Number	:

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

Provider Enumeration Date	:	05/16/2022
Last Update Date	:	03/11/2024

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Directions to “ DR. MICHAEL REIDY ” Practice Location

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