Provider Demographics
NPI:1740400548
Name:REINHART, TRACY LYNN (DMD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:REINHART
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 ROUTE 113
Mailing Address - Street 2:
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-1000
Mailing Address - Country:US
Mailing Address - Phone:215-723-2162
Mailing Address - Fax:215-723-6990
Practice Address - Street 1:775 ROUTE 113
Practice Address - Street 2:
Practice Address - City:SOUDERTON
Practice Address - State:PA
Practice Address - Zip Code:18964-1000
Practice Address - Country:US
Practice Address - Phone:215-723-2162
Practice Address - Fax:215-723-6990
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030990L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice