Provider Demographics
NPI:1447424890
Name:REBER, RICHARD ERLAND (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ERLAND
Last Name:REBER
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 1:1996 E 6400 S
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-2159
Mailing Address - Country:US
Mailing Address - Phone:801-943-2627
Mailing Address - Fax:801-274-2808
Practice Address - Street 1:1996 E 6400 S
Practice Address - Street 2:SUITE 220
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-2159
Practice Address - Country:US
Practice Address - Phone:801-943-2627
Practice Address - Fax:801-274-2808
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4741051-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist