Provider Demographics
NPI:1396837464
Name:REINTJES, BYRON LANE (DDS)
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:LANE
Last Name:REINTJES
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 1:907 E WIMBLEDON DR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-1356
Mailing Address - Country:US
Mailing Address - Phone:559-433-0722
Mailing Address - Fax:
Practice Address - Street 1:7235 N 1ST ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2964
Practice Address - Country:US
Practice Address - Phone:559-438-6684
Practice Address - Fax:559-438-0252
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA383551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice