Provider Demographics
NPI:1285061325
Name:MARK A REBER, DDS. MS, INC.
Entity type:Organization
Organization Name:MARK A REBER, DDS. MS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:REBER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-778-4440
Mailing Address - Street 1:1049 COCHRANE ROAD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037
Mailing Address - Country:US
Mailing Address - Phone:408-778-4440
Mailing Address - Fax:408-778-8338
Practice Address - Street 1:1049 COCHRANE RD
Practice Address - Street 2:#110
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-9077
Practice Address - Country:US
Practice Address - Phone:408-778-4440
Practice Address - Fax:408-778-8338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA336521223G0001X
CA576371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty