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General NPI Number Information
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NPI Number | 1366172652
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Entity Type | Individual
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Provider Name | JUSTIN ALLAN REEB DDS
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Gender | Male
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Dates
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Enumeration Date | 06/10/2022
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Last Update Date | 11/22/2022
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Provider Practice Location Address
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Address Line | 807 W GARDNER DR
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City | MARION
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State | IN
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Zip | 46952-1819
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Country | US
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Telephone | 765-668-8907
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Fax | 765-651-9423
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Provider Business Mailing Address
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Address Line | 807 W GARDNER DR
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City | MARION
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State | IN
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Zip | 46952-1819
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Country | US
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Telephone | 765-668-8907
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Fax | 765-651-9423
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 00205119
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12013912A
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License Number State | IN
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