1790762490 NPI number — DR. DOMINIQUE MICHEL REYNDERS D.D.S.

Table of content: DR. DOMINIQUE MICHEL REYNDERS D.D.S. (NPI 1790762490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790762490 NPI number — DR. DOMINIQUE MICHEL REYNDERS D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REYNDERS
Provider First Name:
DOMINIQUE
Provider Middle Name:
MICHEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790762490
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6900 GEORGIA AVE NW
Provider Second Line Business Mailing Address:
BUILDING T20, ROOM 206A
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20307-0003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-782-0988
Provider Business Mailing Address Fax Number:
202-782-9195

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9515 HALL RD
Provider Second Line Business Practice Location Address:
BUILDING 1099
Provider Business Practice Location Address City Name:
FORT BELVOIR
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22060-5529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-806-4393
Provider Business Practice Location Address Fax Number:
703-806-4376
Provider Enumeration Date:
12/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  7006 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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