Provider Demographics
NPI:1285852541
Name:REBA, GARY JOHN (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:JOHN
Last Name:REBA
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 1:14 TITUS LN
Mailing Address - Street 2:
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-1118
Mailing Address - Country:US
Mailing Address - Phone:609-799-7982
Mailing Address - Fax:
Practice Address - Street 1:322 LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-3457
Practice Address - Country:US
Practice Address - Phone:732-828-5750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ9178122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist