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NPI Code Detail

MEDICARE: REINA L WILSON RDH

MEDICARE:   REINA L WILSON  RDH
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
1124Q00000XDental Hygienist2526KS

General Provider Information

NPI Number : 1720412091
Entity Type Code : Individual
Provider Name (Legal Business Name) : REINA L WILSON RDH
Provider Business Mailing Address
First Line : 3011 N MICHIGAN ST
Second Line :
City : PITTSBURG
State : KS
Zip : 66762-2546
Country : US
Telephone Number : 620-231-9873
Fax Number : 620-231-2808
Provider Business Practice Location Address
First Line : 2051 N STATE ST
Second Line :
City : IOLA
State : KS
Zip : 66749-1677
Country : US
Telephone Number : 620-380-6600
Fax Number : 620-380-6215
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2013
Last Update Date : 03/12/2020

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Directions to “ REINA L WILSON RDH” Practice Location

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