Provider Demographics
NPI:1417024449
Name:LANGE RIDER & REYNOLDS PSC
Entity type:Organization
Organization Name:LANGE RIDER & REYNOLDS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-278-0576
Mailing Address - Street 1:1636 NICHOLASVILLE ROAD
Mailing Address - Street 2:SUITE #7
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503
Mailing Address - Country:US
Mailing Address - Phone:859-278-0576
Mailing Address - Fax:859-276-2478
Practice Address - Street 1:1636 NICHOLASVILLE ROAD
Practice Address - Street 2:SUITE #7
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503
Practice Address - Country:US
Practice Address - Phone:859-278-0576
Practice Address - Fax:859-276-2478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3285122300000X
KY5281122300000X
KY6361122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty