Provider Demographics
NPI:1083628929
Name:REATH, RICHARD W (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:W
Last Name:REATH
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 1:6440 ALPINE AVE NW
Mailing Address - Street 2:SUITE B
Mailing Address - City:COMSTOCK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:49321-8003
Mailing Address - Country:US
Mailing Address - Phone:616-784-3515
Mailing Address - Fax:616-784-1440
Practice Address - Street 1:6440 ALPINE AVE NW
Practice Address - Street 2:SUITE B
Practice Address - City:COMSTOCK PARK
Practice Address - State:MI
Practice Address - Zip Code:49321-8003
Practice Address - Country:US
Practice Address - Phone:616-784-3515
Practice Address - Fax:616-784-1440
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID133121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice