Healthcare Provider Details

I. General information

NPI: 1225963580
Provider Name (Legal Business Name): QUINTEN THOMAS REASONER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 SAMPSON ST
GREAT LAKES IL
60088-2942
US

IV. Provider business mailing address

4565 S WARREN RD
SPRINGFIELD MO
65810-2641
US

V. Phone/Fax

Practice location:
  • Phone: 847-688-2469
  • Fax:
Mailing address:
  • Phone: 417-430-4490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number62395
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: