Provider Demographics
NPI:1568423689
Name:ROBERT REISIG DDS PC
Entity Type:Organization
Organization Name:ROBERT REISIG DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:OGDEN
Authorized Official - Last Name:REISIG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-329-3111
Mailing Address - Street 1:1820 SINCLAIR ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ST CLAIR
Mailing Address - State:MI
Mailing Address - Zip Code:48079
Mailing Address - Country:US
Mailing Address - Phone:810-329-3111
Mailing Address - Fax:810-329-3188
Practice Address - Street 1:1820 SINCLAIR ST
Practice Address - Street 2:SUITE B
Practice Address - City:ST CLAIR
Practice Address - State:MI
Practice Address - Zip Code:48079
Practice Address - Country:US
Practice Address - Phone:810-329-3111
Practice Address - Fax:810-329-3188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901012230122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty