Provider Demographics
NPI:1942636592
Name:REUSSER PLUS REUSSER LLC
Entity Type:Organization
Organization Name:REUSSER PLUS REUSSER LLC
Other - Org Name:REUSSER DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:REUSSER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:316-249-3929
Mailing Address - Street 1:5805 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-4204
Mailing Address - Country:US
Mailing Address - Phone:316-684-8261
Mailing Address - Fax:
Practice Address - Street 1:5805 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4204
Practice Address - Country:US
Practice Address - Phone:316-684-8261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REUSSER PLUS REUSSER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-15
Last Update Date:2013-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS71711223G0001X
KS70101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty