=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306212428
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBIN LYNN REISZ D.D.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2015
-----------------------------------------------------
Last Update Date | 08/04/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1360 E SPRUCE AVE STE 103
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93720-3378
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-860-2500
-----------------------------------------------------
Fax | 559-860-2502
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 755 E NEES AVE UNIT 27046
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93729-8662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-435-7555
-----------------------------------------------------
Fax | 559-435-7444
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 46944
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------