MEDICARE: RANDALL D REINHARDT DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5929	KS

General Provider Information

NPI Number	:	1083794044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDALL D REINHARDT DDS

Provider Business Mailing Address
First Line	:	1905 19TH ST
Second Line	:
City	:	GREAT BEND
State	:	KS
Zip	:	67530-2502
Country	:	US
Telephone Number	:	620-792-5700
Fax Number	:	620-792-5742

Provider Business Practice Location Address
First Line	:	1821 KANSAS AVE
Second Line	:
City	:	GREAT BEND
State	:	KS
Zip	:	67530-2501
Country	:	US
Telephone Number	:	620-603-6838
Fax Number	:	620-792-5742

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	05/08/2019

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