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General NPI Number Information
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NPI Number | 1447424890
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Entity Type | Individual
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Provider Name | RICHARD ERLAND REBER D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/16/2008
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 1996 E 6400 S SUITE 220
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City | SALT LAKE CITY
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State | UT
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Zip | 84121-2159
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Country | US
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Telephone | 801-943-2627
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Fax | 801-274-2808
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Provider Business Mailing Address
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Address Line | 1996 E 6400 S SUITE 220
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City | SALT LAKE CITY
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State | UT
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Zip | 84121-2159
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Country | US
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Telephone | 801-943-2627
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Fax | 801-274-2808
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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 | 4741051-9922
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License Number State | UT
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