MEDICARE: RICHARD E. REBER D.M.D.,PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	4741051-9922	UT

General Provider Information

NPI Number	:	1396968897
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD E. REBER D.M.D.,PC

Provider Business Mailing Address
First Line	:	1996 E 6400 S
Second Line	:	SUITE 220
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-2159
Country	:	US
Telephone Number	:	801-943-2627
Fax Number	:	801-274-2808

Provider Business Practice Location Address
First Line	:	1996 E 6400 S
Second Line	:	SUITE 220
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-2159
Country	:	US
Telephone Number	:	801-943-2627
Fax Number	:	801-274-2808

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RICHARD E REBER
Credential	:	DMD
Telephone Number	:	801-943-2627

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	08/22/2020

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