Provider Demographics
NPI:1245379718
Name:JERRY L. RINEHART, D.D.S.
Entity Type:Organization
Organization Name:JERRY L. RINEHART, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:RINEHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-379-2024
Mailing Address - Street 1:2600 SANDCREST BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-3053
Mailing Address - Country:US
Mailing Address - Phone:812-379-2024
Mailing Address - Fax:
Practice Address - Street 1:2600 SANDCREST BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-3053
Practice Address - Country:US
Practice Address - Phone:812-379-2024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008136A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty