Healthcare Provider Details

I. General information

NPI: 1386754752
Provider Name (Legal Business Name): DAVID BRIAN REEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 DAGGETT DRIVE SUITE 1B
WEST SPRINGFIELD MA
01089-4646
US

IV. Provider business mailing address

46 DAGGETT DRIVE SUITE 1B
WEST SPRINGFIELD MA
01089-4646
US

V. Phone/Fax

Practice location:
  • Phone: 413-733-2477
  • Fax: 413-736-9010
Mailing address:
  • Phone: 413-733-2477
  • Fax: 413-736-9010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number10346
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: