Provider Demographics
NPI:1275748063
Name:REYNOLDS FAMILY DENTISTRY, PA
Entity Type:Organization
Organization Name:REYNOLDS FAMILY DENTISTRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-938-6002
Mailing Address - Street 1:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360-0265
Mailing Address - Country:US
Mailing Address - Phone:864-938-6002
Mailing Address - Fax:864-938-6589
Practice Address - Street 1:85 PROFESSIONAL PARK ROAD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325
Practice Address - Country:US
Practice Address - Phone:864-938-6002
Practice Address - Fax:864-938-6589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9666Medicaid