Provider Demographics
NPI:1275939944
Name:REITER, RONALD IVAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:IVAN
Last Name:REITER
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 1:63 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:FLEETWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19522-9615
Mailing Address - Country:US
Mailing Address - Phone:610-223-0503
Mailing Address - Fax:610-987-0668
Practice Address - Street 1:5000 W TILGHMAN ST
Practice Address - Street 2:SUITE 240
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9109
Practice Address - Country:US
Practice Address - Phone:610-395-4044
Practice Address - Fax:610-395-5693
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO20913L122300000X
PADA020913A1223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDentist Anesthesiologist
No122300000XDental ProvidersDentist