Organization
REIFEIS ORAL SURGERY AND DENTAL IMPLANTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT LOUIS REIFEIS JR. DDS (OWNER)
(260) 602-6454
Entity
Organization
Contact information
Practice address
3303 TRIER RD, FORT WAYNE, IN 46815-4768
(260) 999-4929
(260) 755-1086
Mailing address
16136 COLDWATER RD, FORT WAYNE, IN 46845-9708
(260) 602-6454
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12009415A
INDIANA LICENSE
IN
Enumeration date
10/26/2022
Last updated
05/12/2023
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