| NPI | 1093205130 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT REYNOLDS Dentst/Owner 471-881-3220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 015036) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2018-05-15 |
| Last Update Date | 2018-05-15 |