Healthcare Provider Details

I. General information

NPI: 1932826344
Provider Name (Legal Business Name): REIFEIS ORAL SURGERY AND DENTAL IMPLANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2022
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 Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT LOUIS REIFEIS JR.
Title or Position: OWNER
Credential: DDS
Phone: 260-602-6454