Provider Demographics
NPI:1821201658
Name:REINECK, KURT GARY (DDS)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:GARY
Last Name:REINECK
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 1:720 SW WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-5711
Mailing Address - Country:US
Mailing Address - Phone:817-295-6141
Mailing Address - Fax:817-295-8971
Practice Address - Street 1:720 SW WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-5711
Practice Address - Country:US
Practice Address - Phone:817-295-6141
Practice Address - Fax:817-295-8971
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21288122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist