Provider Demographics
NPI:1548418692
Name:REISIG, ALAN L
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:L
Last Name:REISIG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4427 S SCHRIEBER RD
Mailing Address - Street 2:
Mailing Address - City:HEMLOCK
Mailing Address - State:MI
Mailing Address - Zip Code:48626-9534
Mailing Address - Country:US
Mailing Address - Phone:989-695-2566
Mailing Address - Fax:
Practice Address - Street 1:4427 S SCHRIEBER RD
Practice Address - Street 2:
Practice Address - City:HEMLOCK
Practice Address - State:MI
Practice Address - Zip Code:48626-9534
Practice Address - Country:US
Practice Address - Phone:989-695-2566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL974103122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist