Provider Demographics
NPI:1851879563
Name:REYNOLDS, PAMELA REED (RDH)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:REED
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 WASHINGTON AVE.
Mailing Address - Street 2:
Mailing Address - City:CAPE CHARLES
Mailing Address - State:VA
Mailing Address - Zip Code:23310
Mailing Address - Country:US
Mailing Address - Phone:434-251-4171
Mailing Address - Fax:
Practice Address - Street 1:9159 FRANKTOWN RD
Practice Address - Street 2:
Practice Address - City:FRANKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23310
Practice Address - Country:US
Practice Address - Phone:757-442-4819
Practice Address - Fax:757-442-2264
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402205212124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist