Provider Demographics
NPI:1932252772
Name:FORT WAYNE SMILES PC
Entity Type:Organization
Organization Name:FORT WAYNE SMILES PC
Other - Org Name:DAVID P REICHWAGE DDS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:REICHWAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-426-1086
Mailing Address - Street 1:2031 REED ROAD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815
Mailing Address - Country:US
Mailing Address - Phone:260-426-1086
Mailing Address - Fax:260-424-1046
Practice Address - Street 1:2031 REED ROAD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815
Practice Address - Country:US
Practice Address - Phone:260-426-1086
Practice Address - Fax:260-424-1046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12006980A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty