Provider Demographics
NPI:1578660387
Name:REYNOLDS, PAMELA HLIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:HLIS
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:PAMELA
Other - Middle Name:HLIS
Other - Last Name:RICHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3655 ROSELL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-264-0002
Mailing Address - Fax:404-262-3626
Practice Address - Street 1:3655 ROSELL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-264-0002
Practice Address - Fax:404-262-3626
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8947122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist