Provider Demographics
NPI:1184683740
Name:REETZ, EDWARD A (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:A
Last Name:REETZ
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 BLUE HERON DR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32119-9750
Mailing Address - Country:US
Mailing Address - Phone:386-760-6427
Mailing Address - Fax:
Practice Address - Street 1:926 GREAT POND DR
Practice Address - Street 2:SUITE 2002
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-7244
Practice Address - Country:US
Practice Address - Phone:407-772-5119
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN73981223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics