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General NPI Number Information
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NPI Number | 1104351741
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Entity Type | Organization
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Legal Business Name | REUSSER AND REUSSER LLC
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Dates
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Enumeration Date | 04/20/2017
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Last Update Date | 04/20/2017
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Provider Practice Location Address
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Address Line | 535 S MAIN ST
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City | EL DORADO
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State | KS
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Zip | 67042-3517
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Country | US
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Telephone | 316-321-4222
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Fax |
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Provider Business Mailing Address
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Address Line | 535 S MAIN ST
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City | EL DORADO
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State | KS
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Zip | 67042-3517
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Country | US
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Telephone | 316-321-4222
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | TY REUSSER
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Credential | DDS
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Telephone | 316-321-4222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7010
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License Number State | KS
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