Provider Demographics
NPI:1942556808
Name:REYERING, MATTHEW E (DDS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:E
Last Name:REYERING
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 1:1654 BRYAN RD
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-4897
Mailing Address - Country:US
Mailing Address - Phone:636-978-4848
Mailing Address - Fax:636-978-4862
Practice Address - Street 1:1654 BRYAN RD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-4897
Practice Address - Country:US
Practice Address - Phone:636-978-4848
Practice Address - Fax:636-978-4862
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012017716122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist