Provider Demographics
NPI:1366172652
Name:REEB, JUSTIN ALLAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:ALLAN
Last Name:REEB
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 1:807 W GARDNER DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-1819
Mailing Address - Country:US
Mailing Address - Phone:765-668-8907
Mailing Address - Fax:765-651-9423
Practice Address - Street 1:807 W GARDNER DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-1819
Practice Address - Country:US
Practice Address - Phone:765-668-8907
Practice Address - Fax:765-651-9423
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00205119122300000X
IN12013912A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist