MEDICARE: DR. SHANNI L. REINE-MUTCH DDS

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	122300000X	Dentist	18509	NJ

General Provider Information

NPI Number	:	1639325491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNI L. REINE-MUTCH DDS

Provider Business Mailing Address
First Line	:	817 S CHURCH ST
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-2503
Country	:	US
Telephone Number	:	856-778-2700
Fax Number	:	856-778-2227

Provider Business Practice Location Address
First Line	:	817 S CHURCH ST
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-2503
Country	:	US
Telephone Number	:	856-778-2700
Fax Number	:	856-778-2227

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2008
Last Update Date	:	08/13/2008

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