Healthcare Provider Details

I. General information

NPI: 1285795690
Provider Name (Legal Business Name): VICKI J REICHLEIN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 11/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2039 NE BURNSIDE RD
GRESHAM OR
97030-7998
US

IV. Provider business mailing address

2039 NE BURNSIDE RD
GRESHAM OR
97030-7998
US

V. Phone/Fax

Practice location:
  • Phone: 503-669-7502
  • Fax: 503-669-9832
Mailing address:
  • Phone: 503-669-7502
  • Fax: 503-669-9832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD7358
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: