Provider Demographics
NPI:1790901833
Name:REITER, JOEL BRIAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:BRIAN
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 1:25 MONUMENT ROAD
Mailing Address - Street 2:SUITE #192
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-5049
Mailing Address - Country:US
Mailing Address - Phone:717-741-9593
Mailing Address - Fax:717-741-9151
Practice Address - Street 1:25 MONUMENT RD
Practice Address - Street 2:SUITE #192
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5060
Practice Address - Country:US
Practice Address - Phone:717-741-9593
Practice Address - Fax:717-741-9151
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-024664-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice