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NPI Code Detail

MEDICARE: DR. ROBERT L REIFEIS JR. D.D.S.

MEDICARE: DR. ROBERT L REIFEIS JR. 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
11223S0112XOral and Maxillofacial Surgery (Dentist)12009415AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000379003OTHERINBCBS/ANTHEM
212009415AOTHERININDIANA PROFESSIONAL LICENSING AGENCY

General Provider Information

NPI Number : 1437179140
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT L REIFEIS JR. D.D.S.
Provider Business Mailing Address
First Line : 16136 COLDWATER RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-9708
Country : US
Telephone Number : 260-602-6454
Fax Number :
Provider Business Practice Location Address
First Line : 3303 TRIER RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46815-4768
Country : US
Telephone Number : 260-999-4929
Fax Number : 260-755-1086
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2006
Last Update Date : 05/12/2023

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