Healthcare Provider Details

I. General information

NPI: 1417442252
Provider Name (Legal Business Name): NATHAN GREGORY REUTER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 CENTER DR
GAINESVILLE FL
32610-3006
US

IV. Provider business mailing address

1810 S ENGLISH STATION RD
LOUISVILLE KY
40299-4820
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-5800
  • Fax:
Mailing address:
  • Phone: 502-523-5151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1880
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: