Provider Demographics
NPI:1467686733
Name:MICHAEL O. REIMELS D.D.S. & TODD M. HENDRICKSON D.M.D
Entity Type:Organization
Organization Name:MICHAEL O. REIMELS D.D.S. & TODD M. HENDRICKSON D.M.D
Other - Org Name:FIRST DENTAL OF PINEVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRIMMINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-987-7996
Mailing Address - Street 1:10700 KETTERING DR STE A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-3771
Mailing Address - Country:US
Mailing Address - Phone:704-540-5440
Mailing Address - Fax:704-540-5441
Practice Address - Street 1:10700 KETTERING DR STE A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3771
Practice Address - Country:US
Practice Address - Phone:704-540-5440
Practice Address - Fax:704-540-5441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC79191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5910013Medicaid