Provider Demographics
NPI:1831324219
Name:REYNOLDS, CHRISTOPHER THOMAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:THOMAS
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 ARLEY WAY # B
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-8859
Mailing Address - Country:US
Mailing Address - Phone:843-757-3060
Mailing Address - Fax:843-757-3061
Practice Address - Street 1:12 ARLEY WAY # B
Practice Address - Street 2:SUITE 104
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-8859
Practice Address - Country:US
Practice Address - Phone:843-757-3060
Practice Address - Fax:843-757-3061
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4531122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist