Provider Demographics
NPI:1518604032
Name:REIDENBACH, CALLIANNIE DIXON (DMD)
Entity Type:Individual
Prefix:DR
First Name:CALLIANNIE
Middle Name:DIXON
Last Name:REIDENBACH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 CANAL AVE SE
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-2359
Mailing Address - Country:US
Mailing Address - Phone:330-339-3354
Mailing Address - Fax:330-339-7779
Practice Address - Street 1:313 CANAL AVE SE
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-2359
Practice Address - Country:US
Practice Address - Phone:330-343-0454
Practice Address - Fax:330-339-3354
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.026829122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist