Provider Demographics
NPI:1962447557
Name:ROBIN L. REISZ, DDS. A PROFESSIONAL CORPORATION.
Entity Type:Organization
Organization Name:ROBIN L. REISZ, DDS. A PROFESSIONAL CORPORATION.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:REISZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-435-7555
Mailing Address - Street 1:1105 E SPRUCE AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3313
Mailing Address - Country:US
Mailing Address - Phone:559-250-4478
Mailing Address - Fax:559-431-7830
Practice Address - Street 1:1105 E SPRUCE AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3313
Practice Address - Country:US
Practice Address - Phone:559-435-7555
Practice Address - Fax:559-435-7444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA469441223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty