Provider Demographics
NPI:1437139003
Name:REYNOLDS, WILLIAM GRANT (DMD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GRANT
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 GUNCLUB RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5914
Mailing Address - Country:US
Mailing Address - Phone:843-763-2821
Mailing Address - Fax:
Practice Address - Street 1:NAVAL BRANCH DENTAL CLINIC
Practice Address - Street 2:110 NNPTC CIRCLE
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445
Practice Address - Country:US
Practice Address - Phone:843-764-7944
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice