Healthcare Provider Details

I. General information

NPI: 1962447557
Provider Name (Legal Business Name): ROBIN L. REISZ, DDS. A PROFESSIONAL CORPORATION.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 E SPRUCE AVE SUITE 204
FRESNO CA
93720-3313
US

IV. Provider business mailing address

1105 E SPRUCE AVE SUITE 204
FRESNO CA
93720-3313
US

V. Phone/Fax

Practice location:
  • Phone: 559-435-7555
  • Fax: 559-435-7444
Mailing address:
  • Phone: 559-250-4478
  • Fax: 559-431-7830

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: DR. ROBIN LYNN REISZ
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 559-435-7555