Healthcare Provider Details

I. General information

NPI: 1770092082
Provider Name (Legal Business Name): EMILEE REEDER PHDHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2017
Last Update Date: 09/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 S DUKE ST
LANCASTER PA
17602-4509
US

IV. Provider business mailing address

520 W MARION ST
LITITZ PA
17543-2512
US

V. Phone/Fax

Practice location:
  • Phone: 717-299-6371
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH009574L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: