Healthcare Provider Details

I. General information

NPI: 1437179140
Provider Name (Legal Business Name): ROBERT L REIFEIS JR. D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 TRIER RD
FORT WAYNE IN
46815-4768
US

IV. Provider business mailing address

16136 COLDWATER RD
FORT WAYNE IN
46845-9708
US

V. Phone/Fax

Practice location:
  • Phone: 260-999-4929
  • Fax: 260-755-1086
Mailing address:
  • Phone: 260-602-6454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number12009415A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: