Provider Demographics
NPI:1538255666
Name:REICH, JUSTIN LEROY (DDS)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:LEROY
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 1:9135 ELK GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-2044
Mailing Address - Country:US
Mailing Address - Phone:916-685-9257
Mailing Address - Fax:916-685-8039
Practice Address - Street 1:9135 ELK GROVE BLVD
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2044
Practice Address - Country:US
Practice Address - Phone:916-685-9257
Practice Address - Fax:916-685-8039
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA466751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice