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General NPI Number Information
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NPI Number | 1831784883
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Entity Type | Organization
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Legal Business Name | REYNOLDS ORAL & MAXILLOFACIAL SURGERY, INC
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Dates
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Enumeration Date | 03/02/2021
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 104 VINE ST
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City | PRINCETON
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State | WV
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Zip | 24740-3931
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Country | US
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Telephone | 304-250-1214
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Fax | 681-282-5792
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Provider Business Mailing Address
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Address Line | 104 VINE ST
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City | PRINCETON
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State | WV
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Zip | 24740-3931
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KRISTOPHER REYNOLDS
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Credential |
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Telephone | 304-250-1214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number |
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License Number State |
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