Provider Demographics
NPI:1154524940
Name:REITHER, RANDALL E
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:E
Last Name:REITHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 HIGGINS RD
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-5718
Mailing Address - Country:US
Mailing Address - Phone:847-318-0900
Mailing Address - Fax:
Practice Address - Street 1:800 HIGGINS RD
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-5718
Practice Address - Country:US
Practice Address - Phone:847-318-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice