Provider Demographics
NPI:1083794044
Name:REINHARDT, RANDALL D (DDS)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:D
Last Name:REINHARDT
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 1:1905 19TH ST
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-2502
Mailing Address - Country:US
Mailing Address - Phone:620-792-5700
Mailing Address - Fax:620-792-5742
Practice Address - Street 1:1821 KANSAS AVE
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-2501
Practice Address - Country:US
Practice Address - Phone:620-603-6838
Practice Address - Fax:620-792-5742
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS59291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice