1770653404 NPI number — ROGER J. REICH D.D.S. INC.

Table of content: (NPI 1770653404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770653404 NPI number — ROGER J. REICH D.D.S. INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROGER J. REICH D.D.S. INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770653404
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9727 ELK GROVE FLORIN RD
Provider Second Line Business Mailing Address:
SUITE 270
Provider Business Mailing Address City Name:
ELK GROVE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95624-2264
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-685-2105
Provider Business Mailing Address Fax Number:
916-714-1142

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9727 ELK GROVE FLORIN RD
Provider Second Line Business Practice Location Address:
SUITE 270
Provider Business Practice Location Address City Name:
ELK GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95624-2264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-685-2105
Provider Business Practice Location Address Fax Number:
916-714-1142
Provider Enumeration Date:
11/09/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
REICH
Authorized Official First Name:
ROGER
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
916-685-2105

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)