Provider Demographics
NPI:1154430403
Name:REICH, ROGER J (DDS)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:J
Last Name:REICH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9082 RANCHO DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-2020
Mailing Address - Country:US
Mailing Address - Phone:916-685-2105
Mailing Address - Fax:916-714-1142
Practice Address - Street 1:9727 ELK GROVE FLORIN RD
Practice Address - Street 2:SUITE 270
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2264
Practice Address - Country:US
Practice Address - Phone:916-685-2105
Practice Address - Fax:916-714-1142
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA259741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice