MEDICARE: ADAM REYNOLDS DMD ORTHO LLC

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1720711948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADAM REYNOLDS DMD ORTHO LLC

Provider Business Mailing Address
First Line	:	25 HUGHES RD
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-2238
Country	:	US
Telephone Number	:	256-870-8700
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 HUGHES RD
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-2238
Country	:	US
Telephone Number	:	256-870-8700
Fax Number	:

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	ADAM KEITH REYNOLDS
Credential	:	DMD
Telephone Number	:	256-870-8700

Provider Enumeration Date	:	07/05/2022
Last Update Date	:	07/05/2022

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