Provider Demographics
NPI:1346258324
Name:REICH DENTAL CENTER
Entity Type:Organization
Organization Name:REICH DENTAL CENTER
Other - Org Name:PROFESSIONAL CORPORATION
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:REICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-435-5450
Mailing Address - Street 1:4480 S COBB DR SE STE H
Mailing Address - Street 2:SUITE 530
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6984
Mailing Address - Country:US
Mailing Address - Phone:770-435-5450
Mailing Address - Fax:770-436-7477
Practice Address - Street 1:4849 SOUTH COBB DRIVE SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080
Practice Address - Country:US
Practice Address - Phone:770-435-5450
Practice Address - Fax:770-436-7477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10035122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
BR1263437OtherDEA
BR1263437OtherDEA