Provider Demographics
NPI:1689706970
Name:PAUL M REISCHL DDS INC
Entity Type:Organization
Organization Name:PAUL M REISCHL DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:REISCHL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-492-0166
Mailing Address - Street 1:657 CAMINO DE LOS MARES
Mailing Address - Street 2:STE 245
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673
Mailing Address - Country:US
Mailing Address - Phone:949-492-0166
Mailing Address - Fax:949-493-2291
Practice Address - Street 1:657 CAMINO DE LOS MARES
Practice Address - Street 2:STE 245
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673
Practice Address - Country:US
Practice Address - Phone:949-492-0166
Practice Address - Fax:949-493-2291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34202122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty