MEDICARE: DR. RYAN ILG REICHELT D.M.D.

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	122300000X	Dentist	DN1858185	MA
2	1223G0001X	General Practice Dentistry	DN1858185	MA
3	1223G0001X	General Practice Dentistry	11910	CT
4	1223G0001X	General Practice Dentistry	058692	NY
5	122300000X	Dentist	DN25160	FL

General Provider Information

NPI Number	:	1619350576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN ILG REICHELT D.M.D.

Provider Business Mailing Address
First Line	:	8 TULIP DR
Second Line	:
City	:	LLOYD HARBOR
State	:	NY
Zip	:	11743-9761
Country	:	US
Telephone Number	:	631-742-1877
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 S TAMIAMI TRL STE 205
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34236-7818
Country	:	US
Telephone Number	:	631-742-1877
Fax Number	:

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

Provider Enumeration Date	:	07/09/2015
Last Update Date	:	03/27/2025

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