| NPI | 1437287836 |
|---|---|
| Former Name | STACEY CAMILLE REYNOLDS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 048960) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 14298) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2023-11-06 |