Provider Demographics
NPI:1679790109
Name:REITZENSTEIN, DENNIS E
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:E
Last Name:REITZENSTEIN
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 1:833 SW 11TH AVE STE 619
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2120
Mailing Address - Country:US
Mailing Address - Phone:503-223-5272
Mailing Address - Fax:
Practice Address - Street 1:833 SW 11TH AVE STE 619
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2120
Practice Address - Country:US
Practice Address - Phone:503-223-5272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR666356237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR666356OtherHAS-P OR LICENSE NO.
OR16456-6Medicare PIN