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General NPI Number Information
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NPI Number | 1811169998
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Entity Type | Individual
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Provider Name | MILTON BRADFORD REYNOLDS I DDS
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Gender | Male
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Dates
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Enumeration Date | 03/28/2008
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Last Update Date | 03/28/2008
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Provider Practice Location Address
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Address Line | 1336 HIGHWAY 42 EAST
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City | PETAL
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State | MS
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Zip | 39465-9415
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Country | US
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Telephone | 601-450-3371
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Fax | 601-450-3373
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Provider Business Mailing Address
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Address Line | 1336 HIGHWAY 42 EAST
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City | PETAL
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State | MS
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Zip | 39465-9415
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Country | US
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Telephone | 601-450-3371
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Fax | 601-450-3373
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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 | 2784-94
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License Number State | MS
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