Provider Demographics
NPI:1205869245
Name:REINBOLD, FREDERICK KARL (DMD, MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:KARL
Last Name:REINBOLD
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 ABBOTT RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3867
Mailing Address - Country:US
Mailing Address - Phone:907-562-9939
Mailing Address - Fax:907-562-9929
Practice Address - Street 1:2000 ABBOTT RD STE 200
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-3867
Practice Address - Country:US
Practice Address - Phone:907-562-9939
Practice Address - Fax:907-562-9929
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK9771223S0112X
AK42631223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD64561Medicaid
AKDD64561Medicaid
AKG88275Medicare UPIN