MEDICARE: DR. RUSSELL KAI REYNOLDS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	D8074	OR

General Provider Information

NPI Number	:	1134382344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSELL KAI REYNOLDS DDS

Provider Business Mailing Address
First Line	:	254 PALM AVE
Second Line	:
City	:	ASHLAND
State	:	OR
Zip	:	97520-2232
Country	:	US
Telephone Number	:	541-482-9654
Fax Number	:	541-482-9655

Provider Business Practice Location Address
First Line	:	254 PALM AVE
Second Line	:
City	:	ASHLAND
State	:	OR
Zip	:	97520-2232
Country	:	US
Telephone Number	:	541-482-9654
Fax Number	:	541-482-9655

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2008
Last Update Date	:	07/08/2008

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