Provider Demographics
NPI:1356449946
Name:REOTT, MICHAEL A SR (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:REOTT
Suffix:SR
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 1:4628 COUNTRYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-3671
Mailing Address - Country:US
Mailing Address - Phone:704-530-9729
Mailing Address - Fax:
Practice Address - Street 1:HIGHWAY 321 SOUTH
Practice Address - Street 2:
Practice Address - City:MAIDEN
Practice Address - State:NC
Practice Address - Zip Code:28650-0615
Practice Address - Country:US
Practice Address - Phone:828-428-3737
Practice Address - Fax:704-736-1171
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC49421223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC97342OtherBCBS
NC8797342Medicaid