=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497871768
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHERRI JO REULAND D.D.S., M.S., P.A.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2007
-----------------------------------------------------
Last Update Date | 01/13/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3603 OLD JACKSONVILLE RD
-----------------------------------------------------
City | TYLER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75701-8512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-535-7886
-----------------------------------------------------
Fax | 903-535-7791
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3603 OLD JACKSONVILLE RD
-----------------------------------------------------
City | TYLER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75701-8512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-535-7886
-----------------------------------------------------
Fax | 903-535-7791
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 17874
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------