Provider Demographics
NPI:1154678712
Name:REPUBLIC DENTAL PLLC
Entity Type:Organization
Organization Name:REPUBLIC DENTAL PLLC
Other - Org Name:REPUBLIC DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:REINECKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:830-980-4066
Mailing Address - Street 1:2120 W OAK LAWN RD
Mailing Address - Street 2:STE E
Mailing Address - City:PLEASANTON
Mailing Address - State:TX
Mailing Address - Zip Code:78064
Mailing Address - Country:US
Mailing Address - Phone:830-980-4066
Mailing Address - Fax:
Practice Address - Street 1:2120 W OAK LAWN RD
Practice Address - Street 2:STE E
Practice Address - City:PLEASANTON
Practice Address - State:TX
Practice Address - Zip Code:78064
Practice Address - Country:US
Practice Address - Phone:830-980-4066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty