Provider Demographics
NPI:1972678167
Name:REAMER, RICHARD DANIEL (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:DANIEL
Last Name:REAMER
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 1:1507 MILTARY CUTOFF ROAD
Mailing Address - Street 2:APT 101
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403
Mailing Address - Country:US
Mailing Address - Phone:919-619-4426
Mailing Address - Fax:910-342-9211
Practice Address - Street 1:1611 GREENFIELD ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6455
Practice Address - Country:US
Practice Address - Phone:910-342-9210
Practice Address - Fax:910-342-9211
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC82011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice