Provider Demographics
NPI:1497972210
Name:REINARMAN, ROY HUNTER (DMD)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:HUNTER
Last Name:REINARMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-1901
Mailing Address - Country:US
Mailing Address - Phone:618-654-7461
Mailing Address - Fax:618-654-8032
Practice Address - Street 1:1001 BROADWAY
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249-1901
Practice Address - Country:US
Practice Address - Phone:618-654-7461
Practice Address - Fax:618-654-8032
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice