Provider Demographics
NPI:1114982840
Name:REISER, HAROLD BRIAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:BRIAN
Last Name:REISER
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 1:3115 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-2420
Mailing Address - Country:US
Mailing Address - Phone:215-454-6640
Mailing Address - Fax:215-454-6641
Practice Address - Street 1:3115 KENSINGTON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-2420
Practice Address - Country:US
Practice Address - Phone:215-454-6640
Practice Address - Fax:215-454-6641
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-026567-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101400987Medicaid