Provider Demographics
NPI:1669124186
Name:REETZ, LORI EMERSON (RDH, BSDH)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:EMERSON
Last Name:REETZ
Suffix:
Gender:F
Credentials:RDH, BSDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7251 CANTONMENT CT
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-2861
Mailing Address - Country:US
Mailing Address - Phone:907-632-5308
Mailing Address - Fax:
Practice Address - Street 1:7251 CANTONMENT CT
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-2861
Practice Address - Country:US
Practice Address - Phone:907-632-5308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKDENH800124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist