MEDICARE: DR. CLINTON T 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	122300000X	Dentist	4630	NV

General Provider Information

NPI Number	:	1427136688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLINTON T REYNOLDS DDS

Provider Business Mailing Address
First Line	:	6707 W CHARLESTON BLVD
Second Line	:	STE 4
City	:	LAS VEGAS
State	:	NV
Zip	:	89146
Country	:	US
Telephone Number	:	702-870-5783
Fax Number	:	702-870-3193

Provider Business Practice Location Address
First Line	:	6707 W CHARLESTON BLVD
Second Line	:	STE 4
City	:	LAS VEGAS
State	:	NV
Zip	:	89146
Country	:	US
Telephone Number	:	702-870-5783
Fax Number	:	702-870-3193

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	07/08/2007

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