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General NPI Number Information
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NPI Number | 1447469366
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Entity Type | Organization
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Legal Business Name | MARK M. REYNOLDS D.D.S.
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 10/16/2009
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Provider Practice Location Address
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Address Line | 295 STATE ST
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City | AUGUSTA
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State | ME
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Zip | 04330-7036
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Country | US
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Telephone | 207-622-9210
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Fax |
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Provider Business Mailing Address
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Address Line | 295 STATE ST
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City | AUGUSTA
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State | ME
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Zip | 04330-7036
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Country | US
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Telephone | 207-622-9210
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK MORRISON REYNOLDS
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Credential | D.D.S.
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Telephone | 207-622-9210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 2651
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License Number State | ME
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