Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DN7398 | FL |
NPI | 1184683740 |
---|---|
Provider Name | Dr. Edward A. Reetz |
First Address | Daytona Beach, FL 32119-9750 |
Second Address | Altamonte Springs, FL 32714-7244 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2006 |
Last Update Date | 08/07/2007 |