Healthcare Provider Details

I. General information

NPI: 1093888323
Provider Name (Legal Business Name): JEFFREY LEE REINTGEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 CANDUN DR STE 202
APEX NC
27523-6413
US

IV. Provider business mailing address

2111 W MARILYN CIR
CARY NC
27513-5302
US

V. Phone/Fax

Practice location:
  • Phone: 919-387-7433
  • Fax:
Mailing address:
  • Phone: 919-467-8228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6375
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: