Provider Demographics
NPI:1861384257
Name:REA ORTHO, LLC
Entity type:Organization
Organization Name:REA ORTHO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALKHATIB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-610-3925
Mailing Address - Street 1:6871 ERIE CT
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-2845
Mailing Address - Country:US
Mailing Address - Phone:203-610-3925
Mailing Address - Fax:
Practice Address - Street 1:1021 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-3672
Practice Address - Country:US
Practice Address - Phone:203-610-3925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty