=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861384257
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REA ORTHO, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2025
-----------------------------------------------------
Last Update Date | 01/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1021 COLUMBUS AVE
-----------------------------------------------------
City | MARYSVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43040-3672
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-610-3925
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1021 COLUMBUS AVE UNIT D
-----------------------------------------------------
City | MARYSVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43040-3673
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-303-5343
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ROLA ALKHATIB
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 937-303-5343
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------