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General NPI Number Information
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NPI Number | 1679185482
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Entity Type | Individual
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Provider Name | RACHEL ELIZABETH REYNOLDS DMD
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Gender | Female
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Dates
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Enumeration Date | 08/21/2020
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Last Update Date | 10/18/2023
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Provider Practice Location Address
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Address Line | 4814 OUTER LOOP
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City | LOUISVILLE
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State | KY
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Zip | 40219-3302
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Country | US
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Telephone | 502-546-6272
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Fax |
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Provider Business Mailing Address
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Address Line | 3100 PLOVER RD
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City | LOUISVILLE
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State | KY
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Zip | 40213-1229
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Country | US
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Telephone | 502-794-1389
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12013478A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 11035
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License Number State | KY
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