Provider Demographics
NPI:1598488918
Name:REICH DENTAL CENTER TUCKER PC
Entity Type:Organization
Organization Name:REICH DENTAL CENTER TUCKER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:REICH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:678-534-1010
Mailing Address - Street 1:2295 PARKLAKE DR NE STE 200
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-2812
Mailing Address - Country:US
Mailing Address - Phone:678-534-1010
Mailing Address - Fax:
Practice Address - Street 1:2295 PARKLAKE DR NE STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2812
Practice Address - Country:US
Practice Address - Phone:678-534-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1366837783OtherTYPE 1 NPI