Provider Demographics
NPI:1962577197
Name:REESE, ROBERT RALPH (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:RALPH
Last Name:REESE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6022 TAYLOR DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41005-7840
Mailing Address - Country:US
Mailing Address - Phone:859-689-7725
Mailing Address - Fax:859-689-7726
Practice Address - Street 1:6022 TAYLOR DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:KY
Practice Address - Zip Code:41005-7840
Practice Address - Country:US
Practice Address - Phone:859-689-7725
Practice Address - Fax:859-689-7726
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY47261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice