Provider Demographics
NPI:1568431971
Name:RENO, MICHAEL CHRISTIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CHRISTIAN
Last Name:RENO
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 1:2230 N RIDGE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1053
Mailing Address - Country:US
Mailing Address - Phone:316-722-6060
Mailing Address - Fax:316-721-3277
Practice Address - Street 1:2230 N RIDGE RD
Practice Address - Street 2:SUITE C
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1053
Practice Address - Country:US
Practice Address - Phone:316-722-6060
Practice Address - Fax:316-721-3277
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6973122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist