Provider Demographics
NPI:1598931099
Name:REIAKVAM, PER TERJE (DDS)
Entity Type:Individual
Prefix:DR
First Name:PER
Middle Name:TERJE
Last Name:REIAKVAM
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 1:7400 E CRESTLINE CIR
Mailing Address - Street 2:SUITE #240
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-3652
Mailing Address - Country:US
Mailing Address - Phone:303-759-3969
Mailing Address - Fax:303-996-0072
Practice Address - Street 1:7400 E CRESTLINE CIR
Practice Address - Street 2:SUITE #240
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-3652
Practice Address - Country:US
Practice Address - Phone:303-759-3969
Practice Address - Fax:303-996-0072
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO104787122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist