Provider Demographics
NPI:1508207606
Name:REYNOLDS, BRITTANY SUE (RDH, PHDH)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:SUE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:RDH, PHDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 LHOMME ST
Mailing Address - Street 2:
Mailing Address - City:DANIELSON
Mailing Address - State:CT
Mailing Address - Zip Code:06239-3128
Mailing Address - Country:US
Mailing Address - Phone:888-236-3536
Mailing Address - Fax:888-236-3536
Practice Address - Street 1:145 LHOMME ST
Practice Address - Street 2:
Practice Address - City:DANIELSON
Practice Address - State:CT
Practice Address - Zip Code:06239-3128
Practice Address - Country:US
Practice Address - Phone:888-236-3536
Practice Address - Fax:888-236-3536
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12278124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist