Provider Demographics
NPI:1720209679
Name:REIDENBAUGH, KIM
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:
Last Name:REIDENBAUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 ROYAL DR
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-8220
Mailing Address - Country:US
Mailing Address - Phone:717-626-2355
Mailing Address - Fax:
Practice Address - Street 1:2 S BROAD ST
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-1402
Practice Address - Country:US
Practice Address - Phone:717-626-2355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant