Provider Demographics
NPI:1902112022
Name:DR. DAVID REIFSTECK, PC, INC.
Entity Type:Organization
Organization Name:DR. DAVID REIFSTECK, PC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:REIFSTECK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-684-3277
Mailing Address - Street 1:3320 N COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-2347
Mailing Address - Country:US
Mailing Address - Phone:918-684-3277
Mailing Address - Fax:
Practice Address - Street 1:3320 N COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-2347
Practice Address - Country:US
Practice Address - Phone:918-684-3277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-26
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK40471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty