Provider Demographics
NPI:1932394566
Name:REICH, BRIAN DANIEL (DDS)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:DANIEL
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 1:11973 SAN VICENTE BLVD
Mailing Address - Street 2:SUITE #212
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-5098
Mailing Address - Country:US
Mailing Address - Phone:310-472-6001
Mailing Address - Fax:310-472-6061
Practice Address - Street 1:11973 SAN VICENTE BLVD
Practice Address - Street 2:SUITE #212
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-5098
Practice Address - Country:US
Practice Address - Phone:310-472-6001
Practice Address - Fax:310-472-6061
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice