Provider Demographics
NPI:1780816256
Name:REITER, ROSS (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:
Last Name:REITER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5739 CANTON CV
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-5079
Mailing Address - Country:US
Mailing Address - Phone:407-669-9831
Mailing Address - Fax:
Practice Address - Street 1:5739 CANTON CV
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-5079
Practice Address - Country:US
Practice Address - Phone:407-669-9831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18832122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist