Healthcare Provider Details

I. General information

NPI: 1730318924
Provider Name (Legal Business Name): KYLE W REYNOLDS D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 ALEXANDRIA PIKE STE 100
FORT THOMAS KY
41075-2169
US

IV. Provider business mailing address

725 ALEXANDRIA PIKE STE 100
FORT THOMAS KY
41075-2169
US

V. Phone/Fax

Practice location:
  • Phone: 859-781-0221
  • Fax:
Mailing address:
  • Phone: 859-781-0221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8800
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: