Healthcare Provider Details

I. General information

NPI: 1154495653
Provider Name (Legal Business Name): REYNOLD DREW DONOVAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 E 1ST ST
PORT ANGELES WA
98362-4012
US

IV. Provider business mailing address

240 W FRONT ST STE A
PORT ANGELES WA
98362-2609
US

V. Phone/Fax

Practice location:
  • Phone: 360-452-7891
  • Fax: 360-452-8087
Mailing address:
  • Phone: 360-452-7891
  • Fax: 360-452-8087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60986364
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE60986364
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number37412
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: