Provider Demographics
NPI:1659407401
Name:REUTH, ROBERT A (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:REUTH
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 1:538 E GLORIA SWITCH RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70507-2510
Mailing Address - Country:US
Mailing Address - Phone:337-233-1271
Mailing Address - Fax:337-234-1745
Practice Address - Street 1:538 E GLORIA SWITCH RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70507-2510
Practice Address - Country:US
Practice Address - Phone:337-233-1271
Practice Address - Fax:337-234-1745
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA52241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice