Provider Demographics
NPI:1235673468
Name:REYNOLDS FAMILY DENTISTRY II, LLC
Entity Type:Organization
Organization Name:REYNOLDS FAMILY DENTISTRY II, LLC
Other - Org Name:REYNOLDS FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:SCHAFER
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:812-246-3368
Mailing Address - Street 1:809 S INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-1613
Mailing Address - Country:US
Mailing Address - Phone:812-246-3368
Mailing Address - Fax:812-246-0589
Practice Address - Street 1:809 S INDIANA AVE
Practice Address - Street 2:
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172-1613
Practice Address - Country:US
Practice Address - Phone:812-246-3368
Practice Address - Fax:812-246-0589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120112041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty