MEDICARE: MR. BRIAN DANIEL REICH DDS

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	1223G0001X	General Practice Dentistry	36312	CA

General Provider Information

NPI Number	:	1932394566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN DANIEL REICH DDS

Provider Business Mailing Address
First Line	:	11973 SAN VICENTE BLVD
Second Line	:	SUITE #212
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-5098
Country	:	US
Telephone Number	:	310-472-6001
Fax Number	:	310-472-6061

Provider Business Practice Location Address
First Line	:	11973 SAN VICENTE BLVD
Second Line	:	SUITE #212
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-5098
Country	:	US
Telephone Number	:	310-472-6001
Fax Number	:	310-472-6061

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

Provider Enumeration Date	:	09/06/2007
Last Update Date	:	09/06/2007

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