Provider Demographics
NPI:1346321163
Name:MARK A. REINICKE, D.D.S., P.C.
Entity Type:Organization
Organization Name:MARK A. REINICKE, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:REINICKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-634-5864
Mailing Address - Street 1:3035 BLODGETT DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-4510
Mailing Address - Country:US
Mailing Address - Phone:719-599-3174
Mailing Address - Fax:
Practice Address - Street 1:1539 S 8TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-1916
Practice Address - Country:US
Practice Address - Phone:719-634-5864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO72701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty