Provider Demographics
NPI:1255885505
Name:REISINGER, DAVID ORION (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ORION
Last Name:REISINGER
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 1:1122 WESTGATE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1170
Mailing Address - Country:US
Mailing Address - Phone:708-383-9099
Mailing Address - Fax:708-383-9099
Practice Address - Street 1:1122 WESTGATE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1170
Practice Address - Country:US
Practice Address - Phone:708-383-9099
Practice Address - Fax:708-383-9099
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019030797122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist