Provider Demographics
NPI:1346229689
Name:REYNOLDS, RALPH RICARDO (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:RICARDO
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 E 15TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8938
Mailing Address - Country:US
Mailing Address - Phone:970-663-6878
Mailing Address - Fax:
Practice Address - Street 1:3520 E 15TH ST STE 102
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8938
Practice Address - Country:US
Practice Address - Phone:970-663-6878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO388601223S0112X
CO79081223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery