Provider Demographics
NPI:1689698839
Name:REYNOLDS, GAVIN ERIC (DDS)
Entity Type:Individual
Prefix:
First Name:GAVIN
Middle Name:ERIC
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14073 WESTWIND LN
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-4265
Mailing Address - Country:US
Mailing Address - Phone:540-829-4905
Mailing Address - Fax:
Practice Address - Street 1:6360 VILLAGE CENTER DR
Practice Address - Street 2:
Practice Address - City:BEALETON
Practice Address - State:VA
Practice Address - Zip Code:22712-9315
Practice Address - Country:US
Practice Address - Phone:540-439-1088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010070931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice