Provider Demographics
NPI:1730306804
Name:REINHOLD, GREGORY J (DMD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:J
Last Name:REINHOLD
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 1:108 EDGEWATER LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-3748
Mailing Address - Country:US
Mailing Address - Phone:954-249-6773
Mailing Address - Fax:
Practice Address - Street 1:485 YAMPA AVE
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-2609
Practice Address - Country:US
Practice Address - Phone:970-824-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9083122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO75227363Medicaid