Provider Demographics
NPI:1598896946
Name:REYNOLDS, MARK WILLIAM (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:WILLIAM
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:1304 BEAMAN PL
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-8704
Mailing Address - Country:US
Mailing Address - Phone:336-274-7649
Mailing Address - Fax:336-274-3235
Practice Address - Street 1:1304 BEAMAN PL
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-8704
Practice Address - Country:US
Practice Address - Phone:336-274-7649
Practice Address - Fax:336-274-3235
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC75251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics