MEDICARE: JERRY LEE RINEHART D.D.S.

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	12008136A	IN

General Provider Information

NPI Number	:	1760597397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRY LEE RINEHART D.D.S.

Provider Business Mailing Address
First Line	:	2600 SANDCREST BLVD
Second Line	:	SUITE B
City	:	COLUMBUS
State	:	IN
Zip	:	47203-3053
Country	:	US
Telephone Number	:	812-379-2024
Fax Number	:	812-379-9008

Provider Business Practice Location Address
First Line	:	2600 SANDCREST BLVD
Second Line	:	SUITE B
City	:	COLUMBUS
State	:	IN
Zip	:	47203-3053
Country	:	US
Telephone Number	:	812-379-2024
Fax Number	:	812-379-9008

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/08/2007

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