Provider Demographics
NPI:1235467473
Name:REUTER FAMILY DENTISTRY, L.L.C.
Entity Type:Organization
Organization Name:REUTER FAMILY DENTISTRY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:REUTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-631-1487
Mailing Address - Street 1:206 1ST ST SE
Mailing Address - Street 2:
Mailing Address - City:WADENA
Mailing Address - State:MN
Mailing Address - Zip Code:56482-1561
Mailing Address - Country:US
Mailing Address - Phone:218-631-1487
Mailing Address - Fax:218-631-2972
Practice Address - Street 1:206 1ST ST SE
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-1561
Practice Address - Country:US
Practice Address - Phone:218-631-1487
Practice Address - Fax:218-631-2972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223G0001X, 124Q00000X, 126800000X
MND124241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty