Provider Demographics
NPI:1639325491
Name:REINE-MUTCH, SHANNI L (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHANNI
Middle Name:L
Last Name:REINE-MUTCH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-2503
Mailing Address - Country:US
Mailing Address - Phone:856-778-2700
Mailing Address - Fax:856-778-2227
Practice Address - Street 1:817 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-2503
Practice Address - Country:US
Practice Address - Phone:856-778-2700
Practice Address - Fax:856-778-2227
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18509122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist