Provider Demographics
NPI:1447415666
Name:REYNOLDS, JONATHAN SCHAFER (DMD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:SCHAFER
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 1:809 SOUTH INDIANA AVENUE
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172
Mailing Address - Country:US
Mailing Address - Phone:812-246-3368
Mailing Address - Fax:812-246-0589
Practice Address - Street 1:809 S INDIANA AVE
Practice Address - Street 2:
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172-1613
Practice Address - Country:US
Practice Address - Phone:812-246-3368
Practice Address - Fax:812-246-0589
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011204A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist