Provider Demographics
NPI:1922438753
Name:FAMILY TREE DENTAL D AUSTIN REHL DDS LLC
Entity Type:Organization
Organization Name:FAMILY TREE DENTAL D AUSTIN REHL DDS LLC
Other - Org Name:FAMILY TREE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:AUSTIN
Authorized Official - Last Name:REHL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-374-7060
Mailing Address - Street 1:319 COLEGATE DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-9558
Mailing Address - Country:US
Mailing Address - Phone:740-374-7060
Mailing Address - Fax:740-374-0023
Practice Address - Street 1:319 COLEGATE DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-9558
Practice Address - Country:US
Practice Address - Phone:740-374-7060
Practice Address - Fax:740-374-0023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-14
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300227981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty