Healthcare Provider Details

I. General information

NPI: 1669402517
Provider Name (Legal Business Name): DOUGLAS RICHARD REICH D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7122 RISING SUN AVE
PHILADELPHIA PA
19111-3957
US

IV. Provider business mailing address

6 CROPWELL LN
HOLLAND PA
18966-2583
US

V. Phone/Fax

Practice location:
  • Phone: 215-725-8300
  • Fax: 215-725-8770
Mailing address:
  • Phone: 215-579-4751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS020700L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: