MEDICARE: REYNOLDS CORNERS 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	20857	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962411736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REYNOLDS CORNERS DENTAL

Provider Business Mailing Address
First Line	:	1642 RALSTON CIR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-3801
Country	:	US
Telephone Number	:	419-536-7265
Fax Number	:	419-536-7760

Provider Business Practice Location Address
First Line	:	1642 RALSTON CIR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-3801
Country	:	US
Telephone Number	:	419-536-7265
Fax Number	:	419-536-7760

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SCOTT B KALNIZ
Credential	:	DDS
Telephone Number	:	419-536-7265

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	08/22/2020

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Directions to “REYNOLDS CORNERS DENTAL ” Practice Location

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