Healthcare Provider Details

I. General information

NPI: 1437219524
Provider Name (Legal Business Name): RONALD LEE REICHL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 E CENTRAL
ARLINGTON HGTS IL
60005
US

IV. Provider business mailing address

1112 E CENTRAL
ARLINGTON HGTS IL
60005
US

V. Phone/Fax

Practice location:
  • Phone: 847-398-1334
  • Fax: 847-398-3096
Mailing address:
  • Phone: 847-398-1334
  • Fax: 847-398-3096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number01913063
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: