Provider Demographics
NPI:1760597397
Name:RINEHART, JERRY LEE (DDS)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:LEE
Last Name:RINEHART
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 1:2600 SANDCREST BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-3053
Mailing Address - Country:US
Mailing Address - Phone:812-379-2024
Mailing Address - Fax:812-379-9008
Practice Address - Street 1:2600 SANDCREST BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-3053
Practice Address - Country:US
Practice Address - Phone:812-379-2024
Practice Address - Fax:812-379-9008
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008136A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist