Brock Reichardt, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

27919 Issued in FL

Practice address

941 Tamiami TRL Ste F
Port Charlotte, FL 33953-3121

Phone

(402) 604-0663

NPI assigned

Jun 12, 2023

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Mar 19, 2024 through Mar 19, 2028

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Soul Dental PLLC

  • General Practice Dentistry
  • Port Charlotte, FL
  • NPI 1740115955
  NPD (past)

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

{
    "created_epoch": "1686528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686528000000",
    "number": "1356025209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "941 TAMIAMI TRL STE F",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339533121",
            "telephone_number": "402-604-0663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "941 TAMIAMI TRL STE F",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339533121",
            "telephone_number": "402-604-0663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REICHARDT",
        "first_name": "BROCK",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-12",
        "last_updated": "2023-06-12",
        "certification_date": "2023-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "27919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jenna Lauren Rebeck, APRN
• Susan Reed
• Tyler Thomas Reed, PA
• Yanay Rego Cabrera
• Rehab 1of Charlotte County, Inc.
• Ashley Nichole Reid, PA
• Ronald Alan Reifschneider, D.P.M.
• Yuliya Reimonenq, MD
• Alyssa Reiner
• Jason Eric Reiss, D.O.

• General Practice Dentistry in Port Charlotte, FL
• Providers in Port Charlotte, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.