Healthcare Provider Details

I. General information

NPI: 1306212428
Provider Name (Legal Business Name): ROBIN LYNN REISZ D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 08/04/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 E SPRUCE AVE STE 103
FRESNO CA
93720-3378
US

IV. Provider business mailing address

755 E NEES AVE UNIT 27046
FRESNO CA
93729-8662
US

V. Phone/Fax

Practice location:
  • Phone: 559-860-2500
  • Fax: 559-860-2502
Mailing address:
  • Phone: 559-435-7555
  • Fax: 559-435-7444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number46944
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: