Healthcare Provider Details

I. General information

NPI: 1316936032
Provider Name (Legal Business Name): MARK C RINKEL D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2005
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 UNION ST
LAGRANGE OH
44050-9784
US

IV. Provider business mailing address

117 UNION ST
LAGRANGE OH
44050-9784
US

V. Phone/Fax

Practice location:
  • Phone: 440-355-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30-017169
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: