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General NPI Number Information
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NPI Number | 1689698839
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Entity Type | Individual
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Provider Name | GAVIN ERIC REYNOLDS DDS
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Gender | Male
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6360 VILLAGE CENTER DR
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City | BEALETON
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State | VA
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Zip | 22712-9315
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Country | US
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Telephone | 540-439-1088
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Fax |
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Provider Business Mailing Address
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Address Line | 14073 WESTWIND LN
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City | CULPEPER
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State | VA
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Zip | 22701-4265
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Country | US
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Telephone | 540-829-4905
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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 | 0401007093
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License Number State | VA
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