Randall Craig Reyes, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

015761 Issued in MO

Practice address

2645 Muegge Rd
Saint Charles, MO 63303-3145

Phone

(636) 939-6868

Fax

(636) 447-3611

NPI assigned

Jan 8, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Boulevard Dental Care L.L.C.

  • General Practice Dentistry
  • Saint Charles, MO
  • NPI 1831247048

  General Practice

  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1154479285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11939 MANCHESTER RD",
            "address_2": "SUITE 120",
            "city": "DES PERES",
            "state": "MO",
            "postal_code": "631314502",
            "telephone_number": "636-939-6868",
            "fax_number": "636-447-3611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2645 MUEGGE RD",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633033145",
            "telephone_number": "636-939-6868",
            "fax_number": "636-447-3611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYES",
        "first_name": "RANDALL",
        "middle_name": "CRAIG",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "015761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Ann Rengo-Kocher, MSW
• Megan Renner, DO
• Reorganized School Dist 5
• Amanda Marie Rericker
• Resilient Healing Counseling LLC
• Erin Delaney Reynolds
• Samuel J Rheinhardt, M.D.
• Robin L Rhodes, CRNA
• Lauren C Rice, M.D.
• Dennis J Richards, CO

• All providers in Saint Charles, MO
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.