Provider Demographics
NPI:1821165580
Name:TRI-STATE DENTAL
Entity Type:Organization
Organization Name:TRI-STATE DENTAL
Other - Org Name:DR. JEFF REINKING
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:E
Authorized Official - Last Name:REINKING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:712-255-7123
Mailing Address - Street 1:2410 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-3724
Mailing Address - Country:US
Mailing Address - Phone:712-255-7123
Mailing Address - Fax:712-255-1526
Practice Address - Street 1:2410 PIERCE ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3724
Practice Address - Country:US
Practice Address - Phone:712-255-7123
Practice Address - Fax:712-255-1526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty