Mark George Reitz, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

05302 Issued in VA

Practice address

103 E Broad St
Blackstone, VA 23824-1815

Phone

(434) 292-5318

NPI assigned

Oct 10, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1467540393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 E BROAD ST",
            "city": "BLACKSTONE",
            "state": "VA",
            "postal_code": "238241815",
            "telephone_number": "434-292-5318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 E BROAD ST",
            "city": "BLACKSTONE",
            "state": "VA",
            "postal_code": "238241815",
            "telephone_number": "434-292-5318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REITZ",
        "first_name": "MARK",
        "middle_name": "GEORGE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "05302",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roby Taylor Myers, DC
• Nottoway Innovative Medical Solutions
• Nikhila N Pai
• Phillip D Prater DDD PLLC
• Gabrielle Tiarra Qahhar, NP-C
• Emma Rudebusch, MD
• S & S Health Care, Inc. (Interim HealthCare)
• Safe Helping Hands LLC
• Michaela Nicole Cruz San Juan, MD
• Rauan Satbekov, M.D.

• General Practice Dentistry in Blackstone, VA
• Providers in Blackstone, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.