Provider Demographics
NPI:1417029091
Name:MUSKAT, REOLINA SIDHARTA (DDS)
Entity type:Individual
Prefix:DR
First Name:REOLINA
Middle Name:SIDHARTA
Last Name:MUSKAT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 KIELY BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-5744
Mailing Address - Country:US
Mailing Address - Phone:408-248-4426
Mailing Address - Fax:408-248-0394
Practice Address - Street 1:785 KIELY BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-5744
Practice Address - Country:US
Practice Address - Phone:408-248-4426
Practice Address - Fax:408-248-0394
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42095122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist