Provider Demographics
NPI:1558477760
Name:REESE, MICHAEL JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:REESE
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 1:3070 FISH HATCHERY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53713-3187
Mailing Address - Country:US
Mailing Address - Phone:608-274-6232
Mailing Address - Fax:608-274-9444
Practice Address - Street 1:3070 FISH HATCHERY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53713-3187
Practice Address - Country:US
Practice Address - Phone:608-274-6232
Practice Address - Fax:608-274-9444
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001328-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice