Provider Demographics
NPI:1376860189
Name:REICH, GUY V (DDS)
Entity Type:Individual
Prefix:DR
First Name:GUY
Middle Name:V
Last Name:REICH
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 1:314 PLEASANT AVE S
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-1419
Mailing Address - Country:US
Mailing Address - Phone:218-732-4466
Mailing Address - Fax:218-732-5179
Practice Address - Street 1:314 PLEASANT AVE S
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1419
Practice Address - Country:US
Practice Address - Phone:218-732-4466
Practice Address - Fax:218-732-5179
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8934122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN995818500Medicaid