MEDICARE: DAVID EVERETT REYNOLDS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	3360	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1620840	OTHER	AR	UNITED CONCORDIA
2	5X928	OTHER	AR	BLUE CROSS
3	041200182	OTHER		QUAL CHOICE

General Provider Information

NPI Number	:	1154437788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID EVERETT REYNOLDS DDS

Provider Business Mailing Address
First Line	:	9801 STAGECOACH RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72210-5737
Country	:	US
Telephone Number	:	501-455-6100
Fax Number	:

Provider Business Practice Location Address
First Line	:	9801 STAGECOACH RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72210-5737
Country	:	US
Telephone Number	:	501-455-6100
Fax Number	:	501-455-6103

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	06/06/2022

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