Healthcare Provider Details

I. General information

NPI: 1003572223
Provider Name (Legal Business Name): VICKI J REICHLEIN DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1388 E POWELL BLVD
GRESHAM OR
97030-8004
US

IV. Provider business mailing address

13201 SE BLACKBERRY CIR
PORTLAND OR
97236-4995
US

V. Phone/Fax

Practice location:
  • Phone: 503-328-6388
  • Fax: 503-328-9776
Mailing address:
  • Phone: 971-219-7114
  • Fax: 503-761-0420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier150298
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: DR. VICKI J REICHLEIN
Title or Position: OWNER
Credential: DMD
Phone: 971-219-7114