Provider Demographics
NPI:1578629663
Name:REISCHL, MICHAEL F (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
Last Name:REISCHL
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 1:655 W SMITH ST
Mailing Address - Street 2:STE 206
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-4477
Mailing Address - Country:US
Mailing Address - Phone:253-854-8306
Mailing Address - Fax:253-854-5575
Practice Address - Street 1:655 W SMITH ST
Practice Address - Street 2:STE 206
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-4477
Practice Address - Country:US
Practice Address - Phone:253-854-8306
Practice Address - Fax:253-854-5575
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000054761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA23970OtherDEPT OF L&I PROVIDER #