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General NPI Number Information
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NPI Number | 1538654207
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Entity Type | Individual
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Provider Name | RYAN REITANO DDS
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Gender | Male
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Dates
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Enumeration Date | 06/26/2018
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Last Update Date | 06/26/2018
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Provider Practice Location Address
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Address Line | 6062 INDIAN RIVER RD STE 103
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-3821
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Country | US
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Telephone | 757-615-2893
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Fax |
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Provider Business Mailing Address
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Address Line | 6062 INDIAN RIVER RD STE 103
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-3821
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Country | US
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Telephone | 757-424-0184
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401416107
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License Number State | VA
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