MEDICARE: REUSSER AND REUSSER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1437648490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REUSSER AND REUSSER LLC

Provider Business Mailing Address
First Line	:	2203 N SWEETBRIAR ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67204-5518
Country	:	US
Telephone Number	:	316-838-1300
Fax Number	:

Provider Business Practice Location Address
First Line	:	2203 N SWEETBRIAR ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67204-5518
Country	:	US
Telephone Number	:	316-838-1300
Fax Number	:

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	TY M REUSSER
Credential	:
Telephone Number	:	316-630-9500

Provider Enumeration Date	:	05/05/2018
Last Update Date	:	05/05/2018

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Directions to “REUSSER AND REUSSER LLC ” Practice Location

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