Provider Demographics
NPI:1053634733
Name:RICHARD ALAN REAMER
Entity Type:Organization
Organization Name:RICHARD ALAN REAMER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BULLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-342-9210
Mailing Address - Street 1:736 MEDICAL CENTER DRIVE
Mailing Address - Street 2:SUITE #101
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-4284
Mailing Address - Country:US
Mailing Address - Phone:910-762-0355
Mailing Address - Fax:910-342-9211
Practice Address - Street 1:736 MEDICAL CENTER DRIVE
Practice Address - Street 2:SUITE #101
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-4284
Practice Address - Country:US
Practice Address - Phone:910-762-0355
Practice Address - Fax:910-342-9211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC37141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8997288Medicaid