Provider Demographics
NPI:1669627436
Name:REICK, JOAN MARY (DDS)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:MARY
Last Name:REICK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 CRESTED FERN LN
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1494
Mailing Address - Country:US
Mailing Address - Phone:205-985-0400
Mailing Address - Fax:205-985-0401
Practice Address - Street 1:705 CRESTED FERN LN
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-1494
Practice Address - Country:US
Practice Address - Phone:205-985-0400
Practice Address - Fax:205-985-0401
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL.- 3695122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist