Provider Demographics
NPI:1790883734
Name:REYNOLDS, WENDY D (DDS)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:D
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 E. 61ST ST. N.
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67219
Mailing Address - Country:US
Mailing Address - Phone:316-744-3004
Mailing Address - Fax:316-744-9566
Practice Address - Street 1:410 E. 61ST ST. N.
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67219
Practice Address - Country:US
Practice Address - Phone:316-744-3004
Practice Address - Fax:316-744-9566
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS69591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice