Provider Demographics
NPI:1346387354
Name:REYNOLDS-INCARDONA LTD.
Entity Type:Organization
Organization Name:REYNOLDS-INCARDONA LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT-SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-392-7947
Mailing Address - Street 1:1515 N HARLEM AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1250
Mailing Address - Country:US
Mailing Address - Phone:708-445-0800
Mailing Address - Fax:708-445-0808
Practice Address - Street 1:1515 N HARLEM AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1250
Practice Address - Country:US
Practice Address - Phone:708-445-0800
Practice Address - Fax:708-445-0808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19-0141441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty