Provider Demographics
NPI:1508158940
Name:REEBYE PARK & RICHMAN DDS PLC
Entity Type:Organization
Organization Name:REEBYE PARK & RICHMAN DDS PLC
Other - Org Name:TRIANGLE IMPLANT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TECHNICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:F
Authorized Official - Last Name:HENAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-563-2897
Mailing Address - Street 1:1107 S FIFTH ST STE 250
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-9896
Mailing Address - Country:US
Mailing Address - Phone:919-563-2897
Mailing Address - Fax:
Practice Address - Street 1:1107 S FIFTH ST
Practice Address - Street 2:SUITE 250
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-9597
Practice Address - Country:US
Practice Address - Phone:919-237-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REEBYE PARK & RICHMAN DDS PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-04
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223G0001X, 125Q00000X
NC73811223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No125Q00000XDental ProvidersOral MedicinistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5917450Medicaid