1649761602 NPI number — REEBYE PARK & RICHMAN DDS PLC

Table of content: (NPI 1649761602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649761602 NPI number — REEBYE PARK & RICHMAN DDS PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REEBYE PARK & RICHMAN DDS PLC
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:
TRIANGLE IMPLANT CENTER CARY
Provider Other Organization Name Type Code:
3
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:
1649761602
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1107 S FIFTH ST STE 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEBANE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27302-9896
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-563-2897
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
431 KEISLER DR STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-233-0073
Provider Business Practice Location Address Fax Number:
919-233-2933
Provider Enumeration Date:
05/25/2018

Additional Information

Authorized Official

Authorized Official Last Name:
HENAO
Authorized Official First Name:
ANDRES
Authorized Official Middle Name:
F
Authorized Official Title or Position:
TECHNICAL DIRECTOR
Authorized Official Telephone Number:
919-563-2897

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0106X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223S0112X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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