Provider Demographics
NPI:1801230420
Name:REIZ, IRA (DMD)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:
Last Name:REIZ
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 1:237 KENTLANDS BLVD
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-5446
Mailing Address - Country:US
Mailing Address - Phone:301-987-5200
Mailing Address - Fax:301-987-5511
Practice Address - Street 1:237 KENTLANDS BLVD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-5446
Practice Address - Country:US
Practice Address - Phone:301-987-5200
Practice Address - Fax:301-987-5511
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD110991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice