MEDICARE: EDWARD NEIL REITER D.D.S.

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	9697	TX

General Provider Information

NPI Number	:	1427240761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD NEIL REITER D.D.S.

Provider Business Mailing Address
First Line	:	8620 CALMONT AVE
Second Line	:
City	:	FT. WORTH
State	:	TX
Zip	:	76116-2802
Country	:	US
Telephone Number	:	817-244-6315
Fax Number	:	817-244-4530

Provider Business Practice Location Address
First Line	:	8620 CALMONT AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-2802
Country	:	US
Telephone Number	:	817-244-6315
Fax Number	:	817-244-4530

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2007
Last Update Date	:	08/10/2007

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