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General NPI Number Information
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NPI Number | 1821681073
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Entity Type | Individual
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Provider Name | SHANNON RENAE REINEKE R.D.H.,B.S.H.M.
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Gender | Female
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Dates
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Enumeration Date | 02/18/2021
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Last Update Date | 02/18/2021
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Provider Practice Location Address
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Address Line | WHITSIDE DENTAL CLINIC BUILDING 602 WARRIOR ROAD
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City | FORT RILEY
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State | KS
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Zip | 66442
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Country | US
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Telephone | 785-240-7410
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Fax |
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Provider Business Mailing Address
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Address Line | 2809 BROOKVILLE DR
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City | MANHATTAN
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State | KS
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Zip | 66502-8437
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Country | US
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Telephone | 308-370-1599
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 2516
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License Number State | KS
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