Provider Demographics
NPI:1669402517
Name:REICH, DOUGLAS RICHARD (DMD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:RICHARD
Last Name:REICH
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 1:6 CROPWELL LN
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18966-2583
Mailing Address - Country:US
Mailing Address - Phone:215-579-4751
Mailing Address - Fax:
Practice Address - Street 1:7122 RISING SUN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-3957
Practice Address - Country:US
Practice Address - Phone:215-725-8300
Practice Address - Fax:215-725-8770
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020700L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry