Provider Demographics
NPI:1326395351
Name:REYNOLDS, JOHN SIMPSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SIMPSON
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3277 S CRATER RD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-9285
Mailing Address - Country:US
Mailing Address - Phone:804-732-5776
Mailing Address - Fax:804-732-5782
Practice Address - Street 1:3277 S CRATER RD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9285
Practice Address - Country:US
Practice Address - Phone:804-732-5776
Practice Address - Fax:804-732-5782
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413636122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist