Provider Demographics
NPI:1407115678
Name:REICHGOTT, GEORGE (DDS)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:REICHGOTT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:GEORGE
Other - Middle Name:BRIAN
Other - Last Name:REICHGOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:129 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3751
Mailing Address - Country:US
Mailing Address - Phone:540-434-1904
Mailing Address - Fax:
Practice Address - Street 1:129 UNIVERSITY BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3751
Practice Address - Country:US
Practice Address - Phone:540-434-1904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-09
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010059101223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics