Provider Demographics
NPI:1851663181
Name:REYNOLDS, BRUCE R (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:R
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 1:222 CHALAN SANTO PAPA ST. #304 REFLECTION CENTER
Mailing Address - Street 2:SUITE 304
Mailing Address - City:HAGATNA
Mailing Address - State:GUAM
Mailing Address - Zip Code:96910
Mailing Address - Country:UM
Mailing Address - Phone:671-472-6824
Mailing Address - Fax:671-472-1792
Practice Address - Street 1:222 CHALAN SANTO PAPA ST. #304 REFLECTION CENTER
Practice Address - Street 2:SUITE 304
Practice Address - City:HAGATNA
Practice Address - State:GUAM
Practice Address - Zip Code:96910
Practice Address - Country:UM
Practice Address - Phone:671-472-6824
Practice Address - Fax:671-472-1792
Is Sole Proprietor?:No
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUD4121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice