Provider Demographics
NPI:1356527659
Name:REICH, LAWRENCE A (DDS)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:A
Last Name:REICH
Suffix:
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 1:2106 NEW RD STE C2
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1049
Mailing Address - Country:US
Mailing Address - Phone:609-653-0980
Mailing Address - Fax:609-926-9450
Practice Address - Street 1:2106 NEW RD STE C2
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1049
Practice Address - Country:US
Practice Address - Phone:609-653-0980
Practice Address - Fax:609-926-9450
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ14715122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist