Provider Demographics
NPI:1104847284
Name:EDWARD N. REITER, D.D.S., INC.
Entity Type:Organization
Organization Name:EDWARD N. REITER, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:REITER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-244-6315
Mailing Address - Street 1:8620 CALMONT AVE
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-2802
Mailing Address - Country:US
Mailing Address - Phone:817-244-6315
Mailing Address - Fax:817-244-4530
Practice Address - Street 1:8620 CALMONT AVE
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-2802
Practice Address - Country:US
Practice Address - Phone:817-244-6315
Practice Address - Fax:817-244-4530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9697261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental