Provider Demographics
NPI:1003921792
Name:REYNOLDS, MARTINA MARIE (DDS)
Entity Type:Individual
Prefix:MS
First Name:MARTINA
Middle Name:MARIE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 WEST 57TH ST
Mailing Address - Street 2:SUITE 806
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019
Mailing Address - Country:US
Mailing Address - Phone:212-753-5471
Mailing Address - Fax:212-754-6171
Practice Address - Street 1:57 WEST 57TH ST
Practice Address - Street 2:SUITE 806
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-753-5471
Practice Address - Fax:212-754-6171
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044466122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist