Provider Demographics
NPI:1598057069
Name:REITZ, ERIC JOHN (DMD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JOHN
Last Name:REITZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 LYTLE RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-2736
Mailing Address - Country:US
Mailing Address - Phone:412-831-2188
Mailing Address - Fax:412-831-6360
Practice Address - Street 1:2414 LYTLE RD
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-2736
Practice Address - Country:US
Practice Address - Phone:412-831-2188
Practice Address - Fax:412-831-6360
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019047L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000734348-0001Medicaid