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General NPI Number Information
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NPI Number | 1902234727
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Entity Type | Organization
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Legal Business Name | RANDALL J REYNOLDS DDS, PC
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Dates
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Enumeration Date | 10/15/2013
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Last Update Date | 10/15/2013
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Provider Practice Location Address
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Address Line | 2200 BOX ELDER ST SUITE 121
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City | MILES CITY
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State | MT
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Zip | 59301-2899
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Country | US
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Telephone | 406-232-2214
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 BOX ELDER ST SUITE 121
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City | MILES CITY
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State | MT
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Zip | 59301-2899
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Country | US
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Telephone | 406-232-2214
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Fax |
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Authorized Official
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Title or Position | OFFICE MGR
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Name | JEANETTE J O'DEA
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Credential |
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Telephone | 406-232-2214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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