MEDICARE: HARRIS AND REYNOLDS FAMILY DENTAL

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		AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5F111	OTHER	AR	BLUE CROSS

General Provider Information

NPI Number	:	1730296377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARRIS AND REYNOLDS FAMILY DENTAL

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	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID REYNOLDS
Credential	:	DDS
Telephone Number	:	501-455-6100

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

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