Provider Demographics
NPI:1518375328
Name:HILARY REYNOLDS DDS PC
Entity Type:Organization
Organization Name:HILARY REYNOLDS DDS PC
Other - Org Name:CLEAR LAKE PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:HILARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:641-231-2204
Mailing Address - Street 1:1601 4TH AVENUE SOUTH
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50428
Mailing Address - Country:US
Mailing Address - Phone:641-357-7177
Mailing Address - Fax:
Practice Address - Street 1:1601 4TH AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:IA
Practice Address - Zip Code:50428
Practice Address - Country:US
Practice Address - Phone:641-357-7177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA081861223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty