Collin Vaughn Craig Reid, DDS01/06/

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

61310 Issued in KS

Practice address

1901 W 21St St N
Wichita, KS 67203

Phone

(316) 832-2838

Fax

(316) 832-9530

NPI assigned

Dec 8, 2011

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MD

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bluestar Dental Care

  • Dentist
  • Brooklyn, NY
  • NPI 1720156870
  NPD (past)

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

{
    "created_epoch": "1323302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1508134289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2221 E BIJOU ST STE 100",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809098009",
            "telephone_number": "719-576-1850",
            "fax_number": "719-955-3470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 W 21ST ST N",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "67203",
            "telephone_number": "316-832-2838",
            "fax_number": "316-832-9530"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2110 Rockaway Pkwy",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112365802",
            "country_code": "US",
            "telephone_number": "718-209-8500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REID",
        "first_name": "COLLIN",
        "middle_name": "VAUGHN CRAIG",
        "name_prefix": "Dr.",
        "credential": "DDS01/06/",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-12-08",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KS",
            "license": "61310",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1508134289",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jesi Lyn Reichenberger, PA-C
• Ronald J Reichenberger, M.D.
• Ashton W Reichmann, DPT
• Brandon Robert Reid, MD
• Christina Reid, DO
• Jennifer Reid, LSCSW
• Shatera Reid
• Tabitha Annette Reid, RN
• Victoria Reiff, LSCSW
• Michael P Reiman, PT, ATC, CSCS

• General Practice Dentistry in Wichita, KS
• Providers in Wichita, KS by specialty
• General Practice Dentistry in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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.