Provider Demographics
NPI:1700225141
Name:REYNOLDS, KRISTOPHER NEIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRISTOPHER
Middle Name:NEIL
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 1:104 VINE ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-3931
Mailing Address - Country:US
Mailing Address - Phone:304-250-1214
Mailing Address - Fax:
Practice Address - Street 1:104 VINE ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-3931
Practice Address - Country:US
Practice Address - Phone:304-250-1214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV155204E00000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery