Provider Demographics
NPI:1548785306
Name:AW REYNOLDS JR - DURHAM PLLC
Entity Type:Organization
Organization Name:AW REYNOLDS JR - DURHAM PLLC
Other - Org Name:TROPHY SMILES DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-323-0521
Mailing Address - Street 1:2106 N DUKE ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-4108
Mailing Address - Country:US
Mailing Address - Phone:919-323-0521
Mailing Address - Fax:
Practice Address - Street 1:601 FAYETTEVILLE ST STE 100
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-3997
Practice Address - Country:US
Practice Address - Phone:919-973-0178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARTHUR REYNOLDS JR AND ASSOCIATES P.L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-13
Last Update Date:2017-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC09241261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental