MEDICARE: DR. DAVID HAROLD REIDENBERG DDS

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	12136	NJ

General Provider Information

NPI Number	:	1639225360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID HAROLD REIDENBERG DDS

Provider Business Mailing Address
First Line	:	150 CLOVE RD
Second Line	:
City	:	LITTLE FALLS
State	:	NJ
Zip	:	07424-2138
Country	:	US
Telephone Number	:	973-377-0877
Fax Number	:	973-256-3300

Provider Business Practice Location Address
First Line	:	150 CLOVE RD
Second Line	:
City	:	LITTLE FALLS
State	:	NJ
Zip	:	07424-2138
Country	:	US
Telephone Number	:	973-377-0877
Fax Number	:	973-256-3300

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

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	07/08/2007

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