Provider Demographics
NPI:1386783165
Name:REHDER, KAI DETLEF (DDS)
Entity type:Individual
Prefix:DR
First Name:KAI
Middle Name:DETLEF
Last Name:REHDER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 MATHIAS HAMMOND WAY
Mailing Address - Street 2:#209
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-6359
Mailing Address - Country:US
Mailing Address - Phone:240-346-8875
Mailing Address - Fax:
Practice Address - Street 1:2088 CRAIN HWY
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-3147
Practice Address - Country:US
Practice Address - Phone:301-870-8100
Practice Address - Fax:301-632-5556
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD119991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice