Provider Demographics
NPI:1821134537
Name:REIFENSTAHL, DEAN C JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:C
Last Name:REIFENSTAHL
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 NORTH ELM ST SUITE 305
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-9277
Mailing Address - Country:US
Mailing Address - Phone:413-562-9232
Mailing Address - Fax:413-562-9277
Practice Address - Street 1:94 N ELM ST SUITE 305
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085
Practice Address - Country:US
Practice Address - Phone:413-562-9232
Practice Address - Fax:413-562-9277
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA160711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX05913OtherBC & BS