Provider Demographics
NPI:1194734004
Name:REICHERT, DANIEL A (DDS)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
Last Name:REICHERT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 SHROYER RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-3632
Mailing Address - Country:US
Mailing Address - Phone:937-293-8272
Mailing Address - Fax:937-293-3879
Practice Address - Street 1:924 SHROYER RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45419-3632
Practice Address - Country:US
Practice Address - Phone:937-293-8272
Practice Address - Fax:937-293-3879
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH155791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice