Provider Demographics
NPI:1376806828
Name:YOUNKMAN-REYNOLDS, ASHLEY NICOLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:NICOLE
Last Name:YOUNKMAN-REYNOLDS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19240 QUESADA AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-3126
Mailing Address - Country:US
Mailing Address - Phone:941-743-7435
Mailing Address - Fax:941-743-7429
Practice Address - Street 1:19240 QUESADA AVE
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-3126
Practice Address - Country:US
Practice Address - Phone:941-743-7435
Practice Address - Fax:941-743-7429
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2012-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19749122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist