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General NPI Number Information
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NPI Number | 1447634928
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Entity Type | Organization
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Legal Business Name | MATTHEW REITH DDS PLLC
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Dates
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Enumeration Date | 07/15/2015
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Last Update Date | 07/15/2015
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Provider Practice Location Address
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Address Line | 125B S BLOOMINGTON ST
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City | LOWELL
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State | AR
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Zip | 72745-9493
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Country | US
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Telephone | 479-651-5888
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Fax | 479-770-5004
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Provider Business Mailing Address
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Address Line | 125B S BLOOMINGTON ST
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City | LOWELL
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State | AR
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Zip | 72745-9493
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Country | US
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Telephone | 479-651-5888
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Fax | 479-770-5004
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Authorized Official
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Title or Position | OWNER
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Name | DR. MATTHEW ROBERT REITH
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Credential | DDS
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Telephone | 479-651-5888
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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 | 4057
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License Number State | AR
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