Provider Demographics
NPI:1366469892
Name:REAMER, RICHARD ALAN (DDS)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ALAN
Last Name:REAMER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 MEDICAL CENTER DR.
Mailing Address - Street 2:ST 101
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401
Mailing Address - Country:US
Mailing Address - Phone:910-762-0355
Mailing Address - Fax:910-762-0353
Practice Address - Street 1:736 MEDICAL CENTER DR.
Practice Address - Street 2:ST. 101
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401
Practice Address - Country:US
Practice Address - Phone:910-762-0355
Practice Address - Fax:910-762-0353
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3714122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8997288Medicaid
NC8997288Medicaid