Provider Demographics
NPI:1629199542
Name:REINICKE, MYLENE GLUECKERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:MYLENE
Middle Name:GLUECKERT
Last Name:REINICKE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MYLENE
Other - Middle Name:BARAOIDAN
Other - Last Name:GLUECKERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2960 N CIRCLE DR STE 105
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1163
Mailing Address - Country:US
Mailing Address - Phone:719-597-6300
Mailing Address - Fax:719-597-8266
Practice Address - Street 1:2960 N CIRCLE DR
Practice Address - Street 2:STE 105
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909
Practice Address - Country:US
Practice Address - Phone:719-597-6300
Practice Address - Fax:719-597-8266
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO80101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice