Provider Demographics
NPI:1396968897
Name:RICHARD E. REBER D.M.D.,PC
Entity type:Organization
Organization Name:RICHARD E. REBER D.M.D.,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:REBER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-943-2627
Mailing Address - Street 1:1996 E 6400 S
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-2159
Mailing Address - Country:US
Mailing Address - Phone:801-943-2627
Mailing Address - Fax:801-274-2808
Practice Address - Street 1:1996 E 6400 S
Practice Address - Street 2:SUITE 220
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-2159
Practice Address - Country:US
Practice Address - Phone:801-943-2627
Practice Address - Fax:801-274-2808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4741051-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty