MEDICARE: MATTHEW D. MCREYNOLDS, D.D.S, P.L.L.C.

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	122300000X	Dentist	6855	OK

General Provider Information

NPI Number	:	1710436233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATTHEW D. MCREYNOLDS, D.D.S, P.L.L.C.

Provider Business Mailing Address
First Line	:	8283 S WALKER AVE
Second Line	:	SUITE A
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-9413
Country	:	US
Telephone Number	:	405-632-5561
Fax Number	:	405-632-6301

Provider Business Practice Location Address
First Line	:	8283 S WALKER AVE
Second Line	:	SUITE A
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-9413
Country	:	US
Telephone Number	:	405-632-5561
Fax Number	:	405-632-6301

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MATT MCREYNOLDS
Credential	:	DDS
Telephone Number	:	405-632-5561

Provider Enumeration Date	:	09/26/2016
Last Update Date	:	09/26/2016

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